Organization
PIVOT HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN THOMAS AHLQUIST III MD (OWNER, MD)
(208) 616-1050
Entity
Organization
Contact information
Practice address
808 S VANGUARD WAY, MERIDIAN, ID 83642-7552
(208) 817-2008
Mailing address
PO BOX 44595, BOISE, ID 83711-0595
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
03/31/2021
Last updated
03/31/2021
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