Provider Demographics
NPI:1609245109
Name:TRANSFORMATIONS IDAHO PLLC
Entity Type:Organization
Organization Name:TRANSFORMATIONS IDAHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-639-7300
Mailing Address - Street 1:2857 S MERIDIAN RD
Mailing Address - Street 2:100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7960
Mailing Address - Country:US
Mailing Address - Phone:208-639-7300
Mailing Address - Fax:208-287-8330
Practice Address - Street 1:2857 S MERIDIAN RD
Practice Address - Street 2:100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7960
Practice Address - Country:US
Practice Address - Phone:208-639-7300
Practice Address - Fax:208-287-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty