Organization
MOMENTUM MEDICAL GROUP OF IDAHO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER BEARD (BILLING SERVICE)
(208) 880-0883
Entity
Organization
Contact information
Practice address
8854 W EMERALD ST STE 275, BOISE, ID 83704-4860
(208) 375-3201
Mailing address
8854 W EMERALD ST STE 140, BOISE, ID 83704-4845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/04/2023
Last updated
01/10/2024
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