NPIMap

Organization Active NPI

Renu Medispa

  • Clinic/Center
  • Eagle, ID
National Provider Identifier
1407129125
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
NP784A Issued in ID
Legal business name
RENU MEDISPA
Practice address
951 E Plaza Dr
Suite 150
Eagle, ID 83616-6566
Phone
(208) 939-4456
Fax
(208) 287-2200
NPI assigned
Feb 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Authorized official

Name
Ms. Tawni Weaver
Title
Director
Phone
(208) 939-4456

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NP784A ID Primary

Addresses

Primary practice location

951 E Plaza Dr
Suite 150
Eagle, ID 83616-6566

Mailing address

951 E Plaza Dr
Suite 150
Eagle, ID 83616-6566
Phone (208) 939-4456

National Provider Directory

National Provider Directory

Locations

951 E Plaza Dr
Ste 150
Eagle, ID 83616
Phone (208) 938-2836

NPI Registry JSON

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1407129125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR",
            "address_2": "SUITE 150",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166566",
            "telephone_number": "208-939-4456",
            "fax_number": "208-287-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR",
            "address_2": "SUITE 150",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166566",
            "telephone_number": "208-939-4456",
            "fax_number": "208-287-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENU MEDISPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "TAWNI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-939-4456",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ID",
            "license": "NP784A",
            "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 Apr 30, 2012; 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.