Gen State Integrative Medicine
Organization Active NPI Family Medicine Physician · Meridian, ID
NPI 1790609477 · NPPES record last updated Aug 6, 2026
Key facts
- NPI
- 1790609477
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- GEN STATE INTEGRATIVE MEDICINE
- Practice address
- 1500 East Heritage Park Lane, Suite 150
Suite 150
Meridian, ID 83646 - Phone
- (208) 202-7247
- Fax
- (208) 202-7246
- NPI assigned
- Aug 6, 2026
- Organization subpart
- No
Authorized official
- Name
- Dr. Jennifer Lyn Petrie, MD
- Title
- Owner/President
- Phone
- (208) 365-7131
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1500 East Heritage Park Lane, Suite 150
Suite 150
Meridian, ID 83646
Mailing address
1500 East Heritage Park Lane, Suite 150
Suite 150
Meridian, ID 83646
Phone (208) 202-7247
Other providers in Meridian, ID
- Gem State Developmental Center LLC
- Gem State Developmental Center LLC
- Gem State Pediatrics
- Gem Transport LLC
- Gemstate Pharmacy Group Inc
- Amir Samir Zakhary Gendy
- Genesis Service Dogs Inc
- Genesis Surgical Assisting LLC
- Jane Gennrich
- Katherine Jane Gentry
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 Aug 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.