Provider Demographics
NPI:1477086932
Name:MEDICAL CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:MEDICAL CONSULTING SERVICES, LLC
Other - Org Name:MEDICAL CONSULTING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-514-0518
Mailing Address - Street 1:3023 E COPPER POINT DR
Mailing Address - Street 2:STE 110
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9290
Mailing Address - Country:US
Mailing Address - Phone:208-514-0518
Mailing Address - Fax:208-493-8759
Practice Address - Street 1:3023 E COPPER POINT DR
Practice Address - Street 2:STE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-514-0518
Practice Address - Fax:208-493-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4860261QH0100X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1275642191OtherNPI
ID1275642191Medicaid
IDC92369Medicare UPIN