Provider Demographics
NPI:1124303094
Name:N.E.X.T. LEVEL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:N.E.X.T. LEVEL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:TYRELL
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-528-6010
Mailing Address - Street 1:2105 NIAGARA ST.
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-528-6010
Mailing Address - Fax:208-528-6011
Practice Address - Street 1:2105 NIAGARA
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-528-6010
Practice Address - Fax:208-528-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACT-251261QH0100X
IDCHIA-1341261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808261500Medicaid
ID7478651791Medicare PIN