Organization
TRAILHEAD MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHASE C CHRISTOFFERSEN (OWNER)
(208) 841-7020
Entity
Organization
Contact information
Practice address
2269 E GRAYSON ST, MERIDIAN, ID 83642-5348
(208) 841-7020
Mailing address
2269 E GRAYSON ST, MERIDIAN, ID 83642-5348
(208) 841-7020
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
10/26/2021
Last updated
01/30/2023
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