Idaho Sports Medicine Institute, Pa in Boise - Neuromusculoskeletal Medicine, Sports Medicine
Idaho Sports Medicine Institute, Pa - NPI 1154356624
Idaho Sports Medicine Institute, Pa is a Neuromusculoskeletal Medicine, Sports Medicine in Boise, Idaho. Idaho Sports Medicine Institute, Pa practices all healthcare services and medical treatments related to Neuromusculoskeletal Medicine, Sports Medicine. The NPI Number for Idaho Sports Medicine Institute, Pa is 1154356624. The last update date is 2011-02-25.
Idaho Sports Medicine Institute, Pa's current location address is 1188 University Dr, Boise, Idaho. You can contact this provider via phone number 2083368250 and fax number 2083459514. The mailing address for Idaho Sports Medicine Institute, Pa is 1188 University Dr, Boise, Idaho. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Idaho Sports Medicine Institute, Pa |
|---|---|
| Address | 1188 University Dr, Boise, Idaho |
| Phone Number | 2083368250 |
| Fax Number | 2083459514 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER/PART |
|---|---|
| Authorized Official Name | Millier R. Jennifer |
| Credentials | M.D. |
| Telephone Number | 2083368250 |
NPI Number Detail
| NPI Number | 1154356624 |
|---|---|
| Provider Enumeration Date | 2006-07-12 |
| Last Updated Date | 2011-02-25 |
Provider Mailing Address Detail
| Address | 1188 University Dr |
|---|---|
| City | Boise |
| State | Idaho (ID) |
| Post Code | 837063009 |
| Phone Number | 2083368250 |
| Fax Number | 2083459514 |
Provider's Primary Taxonomy Detail
| Speciality | Neuromusculoskeletal Medicine, Sports Medicine |
|---|---|
| Taxonomy | 204C00000X |
| Licence No | N/A FOR GROU |
|
Definition: A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 805993900 | ID | -- | |
| REGENCE BLUE SH | ID | GROUP # 29145 | |
| 8628-0 | ID | BLUE CROSS OF IDAHO GROUP |
Post Comment/ Review Below
What is the Idaho Sports Medicine Institute, Pa's 1154356624?
The Idaho Sports Medicine Institute, Pa's NPI (National Provider Identifier) Number is 1154356624. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Idaho Sports Medicine Institute, Pa?
The Idaho Sports Medicine Institute, Pa is physically situated at 1188 University Dr, in the city of Boise, state of ID, with the postal code 837063009.
What is the Idaho Sports Medicine Institute, Pa's area of specialization and corresponding taxonomy classification?
The Idaho Sports Medicine Institute, Pa's specialty field is Neuromusculoskeletal Medicine, Sports Medicine, and it falls under the taxonomy code 204C00000X, which categorizes healthcare providers based on their specialties.
On what date did the Centers for Medicare & Medicaid Services assign the 1154356624 to Idaho Sports Medicine Institute, Pa?
The Centers for Medicare & Medicaid Services assigned the 1154356624 to Idaho Sports Medicine Institute, Pa on 2006-07-12.
As of what date were the details related to Idaho Sports Medicine Institute, Pa most recently updated or revised?
The information pertaining to Idaho Sports Medicine Institute, Pa, including its address, specialty, and other relevant details, was last updated or revised on 2011-02-25.
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