1427298025 NPI number — BOISVERT, INC.

Table of content: (NPI 1427298025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427298025 NPI number — BOISVERT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOISVERT, 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:
1427298025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 W WYCLIFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83686-8385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-371-3400
Provider Business Mailing Address Fax Number:
208-467-1737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 1ST AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83687-3498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-371-3400
Provider Business Practice Location Address Fax Number:
208-465-1737
Provider Enumeration Date:
02/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOISVERT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
208-371-3400

Provider Taxonomy Codes

  • Taxonomy code: 344600000X , with the licence number:  QA110135F , 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: 808206800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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