Provider Demographics
NPI:1871560425
Name:3G MEDICAL LLC
Entity type:Organization
Organization Name:3G MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-360-0696
Mailing Address - Street 1:1545 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2129
Mailing Address - Country:US
Mailing Address - Phone:208-552-1000
Mailing Address - Fax:208-523-1295
Practice Address - Street 1:1545 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2129
Practice Address - Country:US
Practice Address - Phone:208-552-1000
Practice Address - Fax:208-523-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332B00000X
AZC001553332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8K826OtherBLUE CROSS PROVIDER #
WY122004700Medicaid
ID806429900Medicaid
ID000010154571OtherREGENCE PROVIDER #
ID600540051OtherAETNA PROVIDER #
ID600540051OtherAETNA PROVIDER #