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RIDGELINE MEDICAL LLC
NPI 1386110963
Family Medicine in Idaho Falls, ID

Active since October 22, 2018CLIA 13D2162276 · Waiver
2470 JAFER CT, IDAHO FALLS, ID 83404(208) 715-9990(208) 715-9992 Get Directions Write a Review

NPPES record last updated: November 1, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 1, 2021, Sep 10, 2020, Jul 28, 2020 and 4 more (7 updates tracked since 2018).

About Ridgeline Medical Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RIDGELINE MEDICAL LLC (NPI 1386110963) is a healthcare organization registered as a family medicine in Idaho Falls, Idaho and active in the NPI registry since October 2018. The organization holds a CLIA Waiver certificate valid through April 11, 2028 and lists Martin Mangan, Owner, as its authorized official.

NPPES Registry Identity

NPI1386110963
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameRIDGELINE MEDICAL LLC
Location Address2470 JAFER CTIdaho Falls, ID 83404-5587
Mailing Address2429 Jafer CtIdaho Falls, ID 83404-5587 · (208) 715-9990 · Fax (208) 715-9992
Phone(208) 715-9990
Fax(208) 715-9992
Organization SubpartNo
Authorized OfficialMartin ManganOwner · (208) 715-9990
Enumeration DateOctober 22, 2018
Last NPPES UpdateNovember 1, 20217 updates tracked since enumeration
NPPES CertifiedNovember 1, 2021
✔ NPI 1386110963 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedChiropractorTaxonomy 111N00000X
Also ListedFamily Medicine · Sleep MedicineTaxonomy 207QS1201X
Also ListedPhysical Medicine & RehabilitationTaxonomy 208100000X
Also ListedClinic/Center · Urgent CareTaxonomy 261QU0200X
2470 JAFER CT, Idaho Falls, ID 83404
Open in Google Maps ↗

Other Names 1

Doing Business AsRidgeline Medical Llc

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include University of Utah Health Plans.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2162276

Ridgeline Medical · Idaho Falls, ID
Active · expires Apr 11, 2028
CLIA Number13D2162276
Laboratory TypePhysician Office
Certificate Effective DateApril 12, 2026
Certificate Expiration DateApril 11, 2028
Laboratory DirectorDanny Spencer
Laboratory Phone(208) 715-9990
Laboratory LocationRidgeline Medical2470 Jafer Ct, Idaho Falls, ID 83404
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TETON CLINICAL PHARMACY INC
Pharmacy (Community/Retail Pharmacy)
2470 JAFER CT
IDAHO FALLS, ID 83404
Bonneville County (208) 529-3636
CHRISTINA MARIE FINNERTY NP
Nurse Practitioner
2470 JAFER CT
IDAHO FALLS, ID 83404
Bonneville County (208) 715-9990

Frequently Asked Questions

What is RIDGELINE MEDICAL LLC's NPI number?

The NPI number assigned to this healthcare provider is 1386110963, enumerated as an "organization" on October 22, 2018.

Where is the provider located?

The provider is located at 2470 JAFER CT IDAHO FALLS, ID 83404 and the phone number is (208) 715-9990.

What is the provider's specialty?

Family Medicine with taxonomy code 207Q00000X.

What insurance does RIDGELINE MEDICAL LLC accept?

The provider might be accepting Accepts: University of Utah Health Plans. Please consult your insurance carrier or call the provider to verify.