Meridian Physical Medicine

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP-1345A Issued in ID

Legal business name

MERIDIAN PHYSICAL MEDICINE

Practice address

2016 S Eagle Rd
Suite B
Meridian, ID 83642-6707

Phone

(208) 887-6810

Fax

(208) 887-6797

NPI assigned

Oct 4, 2016

Organization subpart

No

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

Authorized official

Name

Makayla Runyan

Title

Vice President

Phone

(208) 887-6810

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1881144780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 S EAGLE RD",
            "address_2": "SUITE B",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426707",
            "telephone_number": "208-887-6810",
            "fax_number": "208-887-6797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 S EAGLE RD",
            "address_2": "SUITE B",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426707",
            "telephone_number": "208-887-6810",
            "fax_number": "208-887-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "RUNYAN",
        "authorized_official_first_name": "MAKAYLA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "208-887-6810"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP-1345A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790053338",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meridian Lighthouse Counseling
• Meridian Marriage and Family Therapy, LLC
• Meridian Neuropsychology PLLC
• Meridian Pediatric Dentistry, PLLC
• Meridian Pediatrics
• Meridian Psychological Center PC
• Meridian Smiles Dentistry, PC
• Meridian Therapeutic Massage LLC
• Merkley Cataract and Laser PLLC
• Michael Merkley

• Nurse Practitioner in Meridian, ID
• Providers in Meridian, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; 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.