NPI age
4 years
Enumerated 2021-09-11
● Active Type 2 · Organization
Mangum Primary Care Llc
Mangum Primary Care Llc is 1 of 104 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
2
1 secondary on file
Status
Active
No deactivations on record
Authorized official
Mangum
Owner
Last NPPES update
2021-09-11
Source: monthly bulk 2026-05
How this organization compares
Across 104 active clinic/center providers in Idaho.
NPI age
4 years
↓ 7 yr below median
Practice locations
2
1 secondary on file
Subspecialties
0
NPI lifetime · 2021 → 2026
2021-09Enumerated in NPPES
2021
2026
Where they practice
Primary practice location
3046 S Bown Way
Boise, ID 837065499
Mailing address
608 S Phillippi St
Boise, ID 837051160
Additional practice locations
1 secondary location on file with NPPES.
Location 2
3050 N Lakeharbor Ln Ste 120
Boise, ID 837036917
Authorized official
Meredith Kaye Mangum, FNP-C
Owner
📞 8017938124
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Amber Mallet-Wrout, FNP-C Nurse Practitioner NPI 1114813474
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Multi-provider organization. 1 individual provider on file at this primary address. Plus 1 secondary practice location.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.