Prestige Wellness Clinic

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Legal business name

PRESTIGE WELLNESS CLINIC

Practice address

3749 E 343 N
Rigby, ID 83442-5326

Phone

(208) 705-9800

NPI assigned

Sep 25, 2023

Organization subpart

No

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

Authorized official

Name

Levi Hansen

Title

Ceo

Phone

(208) 705-9800

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1720867153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3749 E 343 N",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425326",
            "telephone_number": "208-705-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3749 E 343 N",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425326",
            "telephone_number": "208-705-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "LEVI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-705-9800"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garret Portela
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• Steven Jared Potter, MD
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• Prosper Dda
• Ranbow LLC
• Quinn Donald Ranson, PA-C
• RBTD
• RBTD Inc

• Medical Physician Assistant in Rigby, ID
• Providers in Rigby, ID by specialty
• Medical Physician Assistant in Idaho

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