Provider Demographics
NPI:1053864736
Name:LOTUS MEDICINE LLC
Entity Type:Organization
Organization Name:LOTUS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSTOM
Authorized Official - Phone:208-720-6711
Mailing Address - Street 1:708 BUTTERCUP RD
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-5073
Mailing Address - Country:US
Mailing Address - Phone:208-720-6711
Mailing Address - Fax:
Practice Address - Street 1:708 BUTTERCUP RD
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-5073
Practice Address - Country:US
Practice Address - Phone:208-720-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-36171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty