Kinghorn Medical LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

KINGHORN MEDICAL LLC

Practice address

248 S Cole Rd
BLDG #7
Boise, ID 83709-0934

Phone

(208) 350-3092

Fax

(208) 901-8185

NPI assigned

Jun 13, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jake Kent Kinghorn, CO-F

Title

Owner

Phone

(208) 350-3092

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mountain Brace Systems Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1821436718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 S COLE RD",
            "address_2": "BLDG #7",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837090934",
            "telephone_number": "208-350-3092",
            "fax_number": "208-901-8185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 S COLE RD",
            "address_2": "BLDG #7",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837090934",
            "telephone_number": "208-350-3092",
            "fax_number": "208-901-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGHORN MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-13",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "KINGHORN",
        "authorized_official_first_name": "JAKE",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-350-3092",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CO-F"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IDTPID009228",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Brace Systems",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Brace Systems",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly King, SLP
• Kimberly Jo King, CPNP-PC
• Neil E King, D.C.
• Rachel King, PA
• Tori Abigail King, PA-C
• Amy Kinghorn, RN
• Britainy Kingsmore
• Sierra S Kinikini
• Anna Felisa Kinney, PA
• Casey Dianne Kinsella, SLP

• Customized Equipment (DME) in Boise, ID
• Providers in Boise, ID by specialty
• Customized Equipment (DME) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.