NPIMap

Organization Active NPI

Family & Functional Medicine of Idaho PLLC

  • Family Medicine Physician
  • Eagle, ID
National Provider Identifier
1114352242
Registry record updated Sep 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0-O370 Issued in ID
Legal business name
FAMILY & FUNCTIONAL MEDICINE OF IDAHO PLLC
Practice address
450 W State St
Suite 250
Eagle, ID 83616-7057
Phone
(208) 947-0925
Fax
(208) 947-0926
NPI assigned
Sep 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela L House, DO
Title
Physician / Owner
Phone
(208) 947-0925

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 0-O370 ID Primary

Addresses

Primary practice location

450 W State St
Suite 250
Eagle, ID 83616-7057

Mailing address

450 W State St
Suite 250
Eagle, ID 83616-7057
Phone (208) 947-0925

National Provider Directory

National Provider Directory
Tax ID family
Family Functional Medicine of Idaho PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378684800000",
    "number": "1114352242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W STATE ST",
            "address_2": "SUITE 250",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167057",
            "telephone_number": "208-947-0925",
            "fax_number": "208-947-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W STATE ST",
            "address_2": "SUITE 250",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167057",
            "telephone_number": "208-947-0925",
            "fax_number": "208-947-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & FUNCTIONAL MEDICINE OF IDAHO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2013-09-09",
        "status": "A",
        "authorized_official_last_name": "HOUSE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN / OWNER",
        "authorized_official_telephone_number": "208-947-0925",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "0-O370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.