1306883244 NPI number — BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC

Table of content: (NPI 1306883244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306883244 NPI number — BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC
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:
1306883244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDPOINT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83864-0908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-263-3410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6615 COMANCHE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-267-1718
Provider Business Practice Location Address Fax Number:
208-267-7739
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNEPPER
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
208-263-3410

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0176255 . This is a "WA LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8H104 . This is a "BLUE CROSS OF IDAHO GROUP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: DB1056 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010142695 . This is a "REGENCE OF IDAHO GROUP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 8905326 . This is a "WA L AND I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 131822 . This is a "MEDICARE FQHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806590100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807823200 . This is a "HEALTHY CONNECTIONS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 806591800 . This is a "HEALTHY CONNECTIONS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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