Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northridge Internal Medicine, PLLC

Organization Internal Medicine Physician · NPI 1033394713

Northridge Internal Medicine, PLLC is an Internal Medicine Physician in Rexburg, Idaho. Licensed in Idaho. Registered with an NPI since 2007.

Licensed in
ID
In the registry since
2007
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

36 Professional Plz STE-102
Rexburg, ID 83440-2049
Phone: (208) 656-8456
Fax: (208) 656-8444
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence O0359 (ID)

Record details

NPI number1033394713
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rodney Bates — Member · (208) 656-8456
NPI enumeratedDecember 31, 2007
Last updated in NPPESFebruary 11, 2008
Mailing address36 Professional Plz, Ste-102, Rexburg, ID 83440-2049

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