Full of Life 5580

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

003513710-S Issued in ID

Legal business name

FULL OF LIFE 5580

Practice address

697 E 1600 N
Idaho Falls, ID 83402-5752

Phone

(208) 521-0155

Fax

(208) 357-7516

NPI assigned

Jan 13, 2010

Last updated

Jan 13, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Willard R Price

Title

Owner

Phone

(208) 521-0155

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1263340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1447580428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "697 E 1600 N",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834025752",
            "telephone_number": "208-521-0155",
            "fax_number": "208-357-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "697 E 1600 N",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834025752",
            "telephone_number": "208-521-0155",
            "fax_number": "208-357-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL OF LIFE 5580",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-13",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "WILLARD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-521-0155"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "003513710-S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Idaho Falls, ID by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; 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.