NPIMap

Organization Active NPI

Mountain States Diabetes Relief, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Idaho Falls, ID
National Provider Identifier
1144783499
Registry record updated Apr 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
MOUNTAIN STATES DIABETES RELIEF, LLC
Practice address
4573 E Majestic
Idaho Falls, ID 83406
Phone
(208) 520-2636
NPI assigned
Apr 12, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2019

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

Authorized official

Name
Katie Davenport
Title
Partner
Phone
(208) 520-2636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

4573 E Majestic
Idaho Falls, ID 83406

Mailing address

4573 E Majestic
Idaho Falls, ID 83406
Phone (208) 520-2636

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555027200000",
    "number": "1144783499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4573 E MAJESTIC",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83406",
            "telephone_number": "208-520-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4573 E MAJESTIC",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83406",
            "telephone_number": "208-520-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES DIABETES RELIEF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-12",
        "last_updated": "2019-04-12",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "208-520-2636"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2019; 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.