NPIMap

Organization Active NPI

Functional Medicine of Idaho PC

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1336656040
Registry record updated Jan 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FUNCTIONAL MEDICINE OF IDAHO PC
Practice address
3858 N Garden Center Way Ste 100
Boise, ID 83703-5008
Phone
(208) 385-7711
Fax
(208) 385-0346
NPI assigned
Jan 3, 2018
Last updated
Jan 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2018

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

Authorized official

Name
Samuel James Warren
Title
President
Phone
(208) 385-7711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

3858 N Garden Center Way Ste 100
Boise, ID 83703-5008

Mailing address

3858 N Garden Center Way Ste 100
Boise, ID 83703-5008
Phone (208) 385-7711

National Provider Directory

National Provider Directory

Locations

3858 N Garden Center Way
#120
Boise, ID 83703

3858 N Garden Center Way
Ste 1
Boise, ID 83703

3858 N Garden Center Way
Ste 120
Boise, ID 83703

434 S Eagle Rd
Ste 100
Eagle, ID 83616

2939 W Excursion Ln
Meridian, ID 83642
Phone (208) 358-7711

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514937600000",
    "number": "1336656040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3858 N GARDEN CENTER WAY STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035008",
            "telephone_number": "208-385-7711",
            "fax_number": "208-385-0346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3858 N GARDEN CENTER WAY STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035008",
            "telephone_number": "208-385-7711",
            "fax_number": "208-385-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL MEDICINE OF IDAHO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-01-03",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-385-7711"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; 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.