Organization
PRAIRIE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA D NEWCOMB MBA, CWCMS (DIRECTOR/OWNER)
(208) 249-1185
Entity
Organization
Contact information
Practice address
1809 N LAKES PL, MERIDIAN, ID 83646-1921
(208) 249-1185
(208) 938-4235
Mailing address
4522 W MORGAN CREEK CT, EAGLE, ID 83616-3359
(208) 249-1185
(208) 938-4235
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
W82971
ID
Other
Enumeration date
09/30/2009
Last updated
04/02/2019
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