1285624627 NPI number — DIVISION OF VETERANS SERVICES

Table of content: (NPI 1285624627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285624627 NPI number — DIVISION OF VETERANS SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVISION OF VETERANS SERVICES
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:
6
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:
1285624627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 COLLINS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83702-4519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-334-5000
Provider Business Mailing Address Fax Number:
208-334-4753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 COLLINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-780-1600
Provider Business Practice Location Address Fax Number:
208-780-1601
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHANER
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY CHIEF ADMINISTRATOR
Authorized Official Telephone Number:
208-780-1320

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  93 , 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: 93 . This is a "NURSING FACILITY LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1307176 . This is a "NCPDP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1639HP . This is a "PHARMACY LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 8058337 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135131 . This is a "MEDICARE/OSCAR" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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