Healthcare Provider Details

I. General information

NPI: 1760487771
Provider Name (Legal Business Name): SINUS CENTER - IDAHO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E RIVERPARK LN STE 200
BOISE ID
83706-4097
US

IV. Provider business mailing address

727 E RIVERPARK LN STE 200
BOISE ID
83706-4097
US

V. Phone/Fax

Practice location:
  • Phone: 208-433-9300
  • Fax: 208-433-9854
Mailing address:
  • Phone: 208-433-9300
  • Fax: 208-433-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: JOHN BOYAJIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 208-433-9300