Provider Demographics
NPI:1285014118
Name:LYON MEDICAL LLC
Entity Type:Organization
Organization Name:LYON MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-251-0414
Mailing Address - Street 1:PO BOX 45179
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5179
Mailing Address - Country:US
Mailing Address - Phone:208-947-5390
Mailing Address - Fax:208-947-3465
Practice Address - Street 1:3080 E GENTRY WAY STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3060
Practice Address - Country:US
Practice Address - Phone:208-947-5390
Practice Address - Fax:208-947-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty