Provider Demographics
NPI:1558109553
Name:LB MEDICAL CONSULTANTS
Entity type:Organization
Organization Name:LB MEDICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:208-738-3446
Mailing Address - Street 1:712 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5746
Mailing Address - Country:US
Mailing Address - Phone:208-207-9422
Mailing Address - Fax:208-269-5828
Practice Address - Street 1:712 2ND AVE N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5746
Practice Address - Country:US
Practice Address - Phone:208-207-9422
Practice Address - Fax:208-269-5828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LB MEDICAL CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty