Premier Life Wellness LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

CHIA-754 Issued in ID

Legal business name

PREMIER LIFE WELLNESS LLC

Practice address

1625 Addison Ave E
Twin Falls, ID 83301-5343

Phone

(208) 735-2442

Fax

(208) 735-9030

NPI assigned

Mar 3, 2008

Organization subpart

No

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

Authorized official

Name

Loraine M Gumper, DC

Title

Owner

Phone

(208) 735-2442

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1952571234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 ADDISON AVE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015343",
            "telephone_number": "208-735-2442",
            "fax_number": "208-735-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 ADDISON AVE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015343",
            "telephone_number": "208-735-2442",
            "fax_number": "208-735-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER LIFE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "GUMPER",
        "authorized_official_first_name": "LORAINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-735-2442",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "ID",
            "license": "CHIA-754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Health Maintenance Organization in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.