First Care Concussion Diagnostic Clinics of Idaho, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

FIRST CARE CONCUSSION DIAGNOSTIC CLINICS OF IDAHO, LLC

Practice address

24641 Blaze Ave
Middleton, ID 83644-6156

Phone

(702) 403-1103

Fax

(385) 365-5054

NPI assigned

Apr 19, 2023

Last updated

Apr 19, 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

Dr. Nathan Dee Miller, DC

Title

Ceo

Phone

(801) 899-2053

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1609563618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1988 W 930 N STE D",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840624132",
            "telephone_number": "702-403-1103",
            "fax_number": "385-365-5054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24641 BLAZE AVE",
            "city": "MIDDLETON",
            "state": "ID",
            "postal_code": "836446156",
            "telephone_number": "702-403-1103",
            "fax_number": "385-365-5054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CARE CONCUSSION DIAGNOSTIC CLINICS OF IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-899-2053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Eastland, LMSW
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• Yvette Michelle Feldman, RN, MSN, ACCNS-P
• Kristin Kae Fendel, D.C.
• Brian Cameron Foreman
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• Natalie France, LCSW
• Beverlee K Furner, NP

• Health Service Clinic/Center in Middleton, ID
• Providers in Middleton, ID by specialty
• Health Service Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.