Milestone Medical LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

MILESTONE MEDICAL LLC

Practice address

1499 Curlew Dr
Ammon, ID 83406-4764

Phone

(208) 529-3342

Fax

(208) 529-6631

NPI assigned

Aug 19, 2024

Organization subpart

No

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

Authorized official

Name

Jed Robertson

Title

Ceo

Phone

(208) 529-3342

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1366274201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 CURLEW DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064764",
            "telephone_number": "208-529-3342",
            "fax_number": "208-529-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 CURLEW DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064764",
            "telephone_number": "208-529-3342",
            "fax_number": "208-529-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILESTONE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-529-3342"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devin Mark McOmber, LPC
• Tiffany McPherson, LCSW
• Dustin Medellin, BS
• Tamara Ann Melville, APRN
• Nicole Mercier, CPSS
• Haylie Ann Miller
• Lakota Miller
• Leslie R Miller, MD
• Denise Milligan, LSW
• Anthony Mitchell, BS

• Medical Specialty Clinic/Center in Ammon, ID
• Providers in Ammon, ID by specialty
• Medical Specialty Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.