Provider Demographics
NPI:1679394308
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:208-207-9422
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0043
Mailing Address - Country:US
Mailing Address - Phone:208-738-3446
Mailing Address - Fax:208-269-5828
Practice Address - Street 1:32 S 150 E
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-5450
Practice Address - Country:US
Practice Address - Phone:208-207-9422
Practice Address - Fax:208-269-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty