Align Integrated Medical LLC
Organization Active NPI Family Medicine Physician · Meridian, ID
NPI 1619484102 · NPPES record last updated Jul 7, 2020
Key facts
- NPI
- 1619484102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ALIGN INTEGRATED MEDICAL LLC
- Practice address
- 750 W Ustick Rd Ste 100
Meridian, ID 83646 - Phone
- (208) 639-1397
- NPI assigned
- Jan 5, 2018
- Organization subpart
- No
Authorized official
- Name
- Chad Woolner
- Title
- Ceo
- Phone
- (208) 639-1397
Practitioners 7
-
Richard King, D.C.
-
Russell C Allen, DC
-
Robyn R Develle, DC, NP-C
-
Brian W Moss, M.D.
-
Chad Michael Woolner, D.C.
-
Kelly Ann Hammerbeck, NP-C
-
Shawn Stadlbauer, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180507002508 | ID | Part B Supplier - Clinic/Group Practice | 7315201993 |
Receives reassigned benefits from 6 practitioners Practice locations: Meridian, ID |
National Provider Directory
Locations
750 W Ustick Rd
Meridian, ID 83646
750 W Ustick Rd
Ste 100
Meridian, ID 83646
Phone (208) 376-0660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
750 W Ustick Rd Ste 100
Meridian, ID 83646
Mailing address
750 W Ustick Rd Ste 100
Meridian, ID 83646-6133
Phone (208) 639-1397
Other providers in Meridian, ID
- Alex Yang Mental Health Services, LLC
- Hannah Alexander-Herrick
- Karen Alexander
- Lisa Alford
- Align Hospice LLC
- Jenna Alix
- All About Home Care
- All in Physical Therapy LLC
- All in Physical Therapy, LLC
- All Paths Counseling LLC
All providers in Meridian, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.