KINGHORN MEDICAL LLC (NPI# 1821436718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821436718 |
| Entity Type | Organization |
| Organization Name | KINGHORN MEDICAL LLC |
| Other Organization Name | MOUNTAIN BRACE SYSTEMS |
| Practice Address |
248 S Cole Rd Bldg #7 Boise ID 83709-0934 |
| Practice Telephone | 2083503092 |
| Practice Fax Number | 2089018185 |
| Mailing Telephone | 2083503092 |
| Mailing Fax Number | 2089018185 |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2017-04-06 |
| Authorized Official Name | MR. JAKE KENT KINGHORN (OWNER) |
| Authorized Official Telephone | 2083503092 |
| Authorized Official Credential | CO-F |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | IDTPID009228 | 05 |
| Other Name | Type Code |
|---|---|
| Mountain Brace Systems | Doing Business As Name - Organization |
| Street Address |
248 S COLE RD BLDG #7 |
| City | BOISE |
| State | ID |
| Zip Code | 83709-0934 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427655398 | Jayme Rossow | Occupational Therapist | 101 S. Allumbaugh Way, Boise, ID 83709 | 2020-10-05 |
| 1578195285 | Kara Taylor | Counselor | 9196 W Barnes St., Boise, ID 83709 | 2020-02-11 |
| 1164080164 | Elena Stamm | Audiologist | 10000 W Amity Rd, Boise, ID 83709 | 2019-06-04 |
| 1326550096 | Lawrence D Anderson Md Estate | Optometrist | 8955 W Hackamore Dr, Boise, ID 83709 | 2017-11-02 |
| 1457879975 | Mark Aaron Phelan | Registered Nurse | 779 S. Tennyson Way, Boise, ID 83709 | 2017-09-05 |
| 1235665290 | Sharon Nelson | Dietitian, Registered | 2790 S Goshen Way, Boise, ID 83709 | 2017-05-11 |
| 1982139622 | First Choice Healthcare, Inc. | Home Health | 12400 W. Overland Rd., Ste 100, Boise, ID 83709 | 2017-05-01 |
| 1801320254 | Deborah Carson | Social Worker | 8349 West Harmonica Way, Boise, ID 83709 | 2017-04-12 |
| 1114479862 | Allyson Anne Bates | Nurse Practitioner | 10583 W Lake Hazel Road, Samg Family Medicine, Boise, ID 83709 | 2016-10-28 |
| 1508221391 | Elisha L. Garrison | Counselor | 9196 W. Barnes Street, Boise, ID 83709 | 2015-12-21 |
| Find all providers in zip 83709 | ||||
| Taxonomy Code | 332BC3200X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Customized Equipment |
| Definition to come... |
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| 1801997234 | Intermountain Ocular Prosthetics, Inc. | Durable Medical Equipment & Medical Supplies | 2308 W Overland Rd, Boise, ID 83705-3152 | 2006-09-26 |
| 1356372221 | Dondell Inc. | Durable Medical Equipment & Medical Supplies | 125 S Curtis Rd, Boise, ID 83705-1014 | 2006-07-06 |
| 1396706958 | Roswell Home Medical Inc | Durable Medical Equipment & Medical Supplies | 11525 W Fairview Ave, Boise, ID 83713-7835 | 2006-03-31 |
| 1851898415 | Michael Shipp Dmd, P.a. | Durable Medical Equipment & Medical Supplies | 6085 N Eagle Rd, Boise, ID 83713-0997 | 2018-04-10 |
| 1366691818 | Rosendahl Foot and Shoe Center | Durable Medical Equipment & Medical Supplies | 125 S Curtis Rd, Boise, ID 83705-1014 | 2008-09-09 |
| 1912171836 | Life's Choices, Inc | Durable Medical Equipment & Medical Supplies | 420 S Orchard St, Boise, ID 83705-1238 | 2008-04-22 |
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|---|---|---|---|---|
| 1427659408 | Sawtooth Physical Therapy | Durable Medical Equipment & Medical Supplies | 16816 N Marketplace Blvd, Nampa, ID 83687-5140 | 2020-11-05 |
| 1285194134 | Brent Earl Parker Jr. | Durable Medical Equipment & Medical Supplies | 4715 E 200 N, Rigby, ID 83442-5954 | 2019-03-25 |
| 1356876726 | Norco, Inc | Durable Medical Equipment & Medical Supplies | 204 W Ironwood Dr Ste 204, Coeur D Alene, ID 83814-1411 | 2017-04-24 |
| 1679938294 | Foot and Ankle Clinic of Spokane Inc | Durable Medical Equipment & Medical Supplies | 8944 N Hess St # A, Hayden, ID 83835-9183 | 2015-12-25 |
| 1174890628 | Norco, Inc | Durable Medical Equipment & Medical Supplies | 1350 Parkway Dr Ste 26, Blackfoot, ID 83221-1657 | 2011-11-29 |
| 1093091555 | Nationwidebath Com LLC | Durable Medical Equipment & Medical Supplies | 647 S Stibnite Ave, Kuna, ID 83634-1992 | 2011-10-28 |
| 1154618510 | Bellevue Healthcare II Inc | Durable Medical Equipment & Medical Supplies | 115 E Harrison Ave, Coeur D Alene, ID 83814-3238 | 2011-07-06 |
| 1477877934 | United Seating and Mobility LLC | Durable Medical Equipment & Medical Supplies | 1270 E Fairview Ave, Suite 150, Meridian, ID 83642-1844 | 2010-03-26 |
| 1700055209 | Breakaway, Inc | Durable Medical Equipment & Medical Supplies | 106 E 39th St, Garden City, ID 83714-6440 | 2008-02-28 |
| 1225192859 | Norco, Inc | Durable Medical Equipment & Medical Supplies | 223 W 3rd St, Moscow, ID 83843-2202 | 2006-12-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.