Provider Demographics
NPI:1891192555
Name:FIT 4 LIFE INTEGRATED HEALTH CLINIC
Entity Type:Organization
Organization Name:FIT 4 LIFE INTEGRATED HEALTH CLINIC
Other - Org Name:FIT 4 LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARZMIK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-391-3484
Mailing Address - Street 1:2086 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6490
Mailing Address - Country:US
Mailing Address - Phone:208-391-3484
Mailing Address - Fax:
Practice Address - Street 1:2086 E 25TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6490
Practice Address - Country:US
Practice Address - Phone:208-391-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-29222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty