Organization
KINGHORN MEDICAL LLC
Active
Other names
Mountain Brace Systems
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAKE KENT KINGHORN CO-F (OWNER)
(208) 350-3092
Entity
Organization
Contact information
Practice address
248 S COLE RD, BLDG #7, BOISE, ID 83709-0934
(208) 350-3092
(208) 901-8185
Mailing address
248 S COLE RD, BLDG #7, BOISE, ID 83709-0934
(208) 350-3092
(208) 901-8185
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID009228
—
ID
Enumeration date
06/13/2013
Last updated
09/20/2024
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