Nutritional Medicine of Idaho

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

D043 Issued in ID

Legal business name

NUTRITIONAL MEDICINE OF IDAHO

Practice address

1520 W State St
Suite 220
Boise, ID 83702-4085

Phone

(208) 343-3883

Fax

(208) 287-2010

NPI assigned

Feb 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Matthew R Macha, M.D.

Title

Owner

Phone

(208) 343-3883

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1467621383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 W STATE ST",
            "address_2": "SUITE 220",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024085",
            "telephone_number": "208-343-3883",
            "fax_number": "208-287-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 W STATE ST",
            "address_2": "SUITE 220",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024085",
            "telephone_number": "208-343-3883",
            "fax_number": "208-287-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRITIONAL MEDICINE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "MACHA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-343-3883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "ID",
            "license": "D043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nutrition Education Nutritionist in Boise, ID
• Providers in Boise, ID by specialty
• Nutrition Education Nutritionist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; 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.