Meridian Advanced Psychiatry , LLC
Organization Active NPI Addiction Medicine (Psychiatry & Neurology) Physician · Meridan, ID
NPI 1609412683 · NPPES record last updated May 12, 2020
Key facts
- NPI
- 1609412683
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X
- Legal business name
- MERIDIAN ADVANCED PSYCHIATRY , LLC
- Practice address
- 1672 S Woodsage Ave.
Meridan, ID 83642 - Phone
- (208) 515-2273
- Fax
- (208) 515-2274
- NPI assigned
- Nov 25, 2019
- Organization subpart
- No
Authorized official
- Name
- Kevin Hulsey
- Title
- Ceo
- Phone
- (208) 789-0202
Subparts reporting this organization as parent 1
Member organizations 1
Practitioners 45
-
Daniel Rulon Anderson, PMHNP-BC
-
Hayden Beard, DNP
-
Dean Bigelow, PMHNP
-
Megan Lee Brock, PMNHP
-
Jamie Bumgardner, PMHNP-BC
-
Jeremiah Robins Clark, FNP-BC
-
Matthew Fowler, AGNP-C
-
Kennedy Nikell Friesen, PMHNP-BC
-
Dianne Yvonne Head, PMHNP-BC
-
Lenard L Malmin Jr., CNP
-
Bradley Martin, PMHNP
-
Barbara McGee Strauss, PMHNP
-
Rebecca Jane McGrath, PMHNP
-
McKenzie Mary Morcom, CNP, PMHNP-BC
-
Babatunde Samuel Olowu, PMHNP-BC
-
Leslie Pardue, APRN, PMHNP-BC
-
Mary Hannah Rankin, FNP
-
Kyle Joseph Ronnau, ARNP
-
Carmen Marie Stephens, DNP-PMHNP
-
Allison Zartman, NP
-
Cheryl Kathryn Burris, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D2179364 | Meridian Advanced Psychiatry LLC | Certificate of waiver | Feb 20, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200618000604 | ID | Part B Supplier - Clinic/Group Practice | 8628490711 |
Receives reassigned benefits from 39 practitioners Practice locations: Meridian, ID |
National Provider Directory
Locations
6945 W Emerald St
Boise, ID 83704
12210 W Amity Rd
Boise, ID 83709
211 E Logan St
Ste 301
Caldwell, ID 83605
1672 S Woodsage Ave
Ste 120
Meridian, ID 83642
Phone (208) 515-2273
1672 S Woodsage Ave
Meridian, ID 83642
Phone (208) 515-2273
4783 N Summit Way
#100
Meridian, ID 83646
1660 S Woodsage Ave
Meridian, ID 83642
Phone (208) 515-2273
920 S Rising Sun Dr
#120
Nampa, ID 83686
Phone (208) 515-2273
358 Cheney Dr W
Ste 101A
Twin Falls, ID 83301
Phone (208) 515-2273
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician |
2084A0401X | Yes |
Addresses
Primary practice location
1672 S Woodsage Ave.
Meridan, ID 83642
Mailing address
1672 S Woodsage Avenue
Suite #120
Meridan, ID 83642
Phone (208) 515-2273
Other practice location 1
1660 S Woodsage Ave
Meridian, ID 83642-7670
Phone (208) 515-2273
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.