Basic Information
| Provider Information | |||||||||
| NPI: | 1891315644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RATUS IP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2321 E GALA ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836427692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082882280 | ||||||||
| FaxNumber: | 2082881544 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 N ALLUMBAUGH ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082882280 | ||||||||
| FaxNumber: | 2082881544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GILLIES | ||||||||
| AuthorizedOfficialFirstName: | KATIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2088885848 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RATUS PLLC | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.