Healthcare Provider Details

I. General information

NPI: 1629093497
Provider Name (Legal Business Name): WOMAN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST SUITE 400
BOISE ID
83712-6223
US

IV. Provider business mailing address

100 E IDAHO ST SUITE 400
BOISE ID
83712-6223
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-5250
  • Fax: 208-345-2364
Mailing address:
  • Phone: 208-345-5250
  • Fax: 208-345-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY SCHIRER
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-345-5250