Provider Demographics
NPI:1295138261
Name:AT HOME MEDICAL PARTNERS, PLLC
Entity type:Organization
Organization Name:AT HOME MEDICAL PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-286-8670
Mailing Address - Street 1:PO BOX 45698
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5698
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:2014-10-03
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1247A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty