Healthcare Provider Details

I. General information

NPI: 1083098727
Provider Name (Legal Business Name): THE NEIGHBORHOOD CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 N CLOVERDALE RD
BOISE ID
83713-3610
US

IV. Provider business mailing address

PO BOX 1176
MERIDIAN ID
83680-1176
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-5073
  • Fax: 208-376-0269
Mailing address:
  • Phone: 208-376-7298
  • Fax: 208-377-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JASON FLETCHER
Title or Position: OWNER
Credential:
Phone: 208-376-7298