Provider Demographics
NPI:1245709807
Name:CONNECTED MEDICAL GROUP LLC
Entity type:Organization
Organization Name:CONNECTED MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEE ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-936-8206
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-0271
Mailing Address - Country:US
Mailing Address - Phone:435-535-1668
Mailing Address - Fax:435-245-1711
Practice Address - Street 1:724 S 1600 W STE A
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4347
Practice Address - Country:US
Practice Address - Phone:385-498-0102
Practice Address - Fax:385-900-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty