Organization · Type 2 NPI

Spark Med Spa, LLC

Health Service Clinic/Center · Hayden, ID

NPI number 1376246884 Active

Practice location

8027 N Government Way, Suite 106
Hayden, ID 83835

Call (208) 241-9422 Map

Mailing address

PO Box 1021
Athol, ID 83801-6009

Other practice locations

1352 E Center St Ste B, Pocatello, ID 83201-4702 · (208) 241-9942

Specialties and licenses

Taxonomy	Code	License
Health Service Clinic/Center Primary	261QH0100X	None listed

Health Service Clinic/Center: Definition to come...

Other health service clinic/center providers in Hayden

1st ClinicHealth Service Clinic/Center Hayden, ID NPI 1841444015

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NPI record

NPI: 1376246884
Entity type: Organization (Type 2)
Issued: Mar 23, 2023
Last updated: May 28, 2025
Status: Active
Subpart: Yes of Spark Med Spa, LLC

Other names

<unavail>
Spark Med Spa · doing business as
Spark Med Spa · doing business as

Authorized official

Robbie J Garrett, RN
Co-Owner/director
(208) 251-2660

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1376246884

Spark Med Spa, LLC's National Provider Identifier is 1376246884, issued on Mar 23, 2023. The primary taxonomy on file is Health Service Clinic/Center (261QH0100X), and the practice location is in Hayden, ID. The record was last updated on May 28, 2025.