Healthcare Provider Details

I. General information

NPI: 1609885870
Provider Name (Legal Business Name): N S SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 W CURTISIAN AVE SUITE 400
BOISE ID
83704
US

IV. Provider business mailing address

6140 W CURTISIAN AVE STE 400
BOISE ID
83704-8907
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3500
  • Fax: 208-367-3500
Mailing address:
  • Phone: 208-327-5600
  • Fax: 208-327-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY REDIKER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 208-327-5631