Health & Wellness Center of Idaho PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M8241 Issued in ID

Legal business name

HEALTH & WELLNESS CENTER OF IDAHO PLLC

Practice address

2001 S Woodruff Ave
Suite 5
Idaho Falls, ID 83404-6374

Phone

(208) 528-8777

Fax

(208) 528-9777

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Eric W Perttula, M.D.

Title

Owner

Phone

(208) 528-8777

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1306981782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "SUITE 5",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "208-528-8777",
            "fax_number": "208-528-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE",
            "address_2": "SUITE 5",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046374",
            "telephone_number": "208-528-8777",
            "fax_number": "208-528-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH & WELLNESS CENTER OF IDAHO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "PERTTULA",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-528-8777",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M8241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8069929",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; 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.