Trailhead Medical Group LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

TRAILHEAD MEDICAL GROUP LLC

Practice address

2269 E Grayson St
Meridian, ID 83642-5348

Phone

(208) 841-7020

NPI assigned

Oct 26, 2021

Last updated

Jan 30, 2023By 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

Chase C Christoffersen

Title

Owner

Phone

(208) 841-7020

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1457015422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2269 E GRAYSON ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425348",
            "telephone_number": "208-841-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2269 E GRAYSON ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425348",
            "telephone_number": "208-841-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAILHEAD MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-26",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "CHRISTOFFERSEN",
        "authorized_official_first_name": "CHASE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-841-7020"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.