| NPI | 1386110963 |
|---|---|
| Doing Business As | RIDGELINE MEDICAL LLC |
| Entity Type | Organization |
| Authorized Contact | MARTIN MANGAN Owner 208-715-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207QS1201X Family Medicine, Sleep Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2021-11-01 |