1316003379 NPI number — BOISE COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316003379 NPI number — BOISE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOISE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316003379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDAHO CITY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-392-6066
Provider Business Mailing Address Fax Number:
208-392-6066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BOISE COUNTY OFFICE
Provider Second Line Business Practice Location Address:
420 MAIN STREET
Provider Business Practice Location Address City Name:
IDAHO CITY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-392-4431
Provider Business Practice Location Address Fax Number:
208-392-4473
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNING
Authorized Official First Name:
JILL
Authorized Official Middle Name:
CHERI
Authorized Official Title or Position:
DEPUTY CLERK EBCAD ACCOUNTS RECEIVA
Authorized Official Telephone Number:
208-392-6066

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  5430 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002807600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 295878726 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 239843900 . This is a "OWC WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010014380 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: E0732 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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