Amh Series II Id, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

AMH SERIES II ID, LLC

Doing business as

Ageless Men's Health

Practice address

1545 E Iron Eagle Dr Ste 101
Eagle, ID 83616-7079

Phone

(208) 906-9128

NPI assigned

Feb 21, 2022

Last updated

Nov 11, 2024By 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

Amanda Wilkinson

Title

Business Operations Director

Phone

(702) 818-0446

Specialties & licenses 1

Addresses

Other names 1

• Ageless Men's Health Doing business as

Tax ID family

Ageless Men's Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Amh Series II Id, LLC

  dba Ageless Men's Health

  • Family Medicine Physician
  • Meridian, ID
  • NPI 1457983462
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Caitlyn Boeck, FNP

  • Family Nurse Practitioner
  • Meridian, ID
  • NPI 1063197713
  NPD (past)

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1649925389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 E IRON EAGLE DR STE 101",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 E IRON EAGLE DR STE 101",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167079",
            "telephone_number": "208-906-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMH SERIES II ID, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-21",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "702-818-0446"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageless Men's Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ageless Men's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jacalyn Renae Amrine, D.C.
• Anchor Path Support Services LLC
• Anchored Support NW LLC
• Jacqueline Andazola
• Katherine Hawkins Andrews, PA-C

• Family Medicine Physician in Eagle, ID
• Providers in Eagle, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.