Healthcare Provider Details

I. General information

NPI: 1356089973
Provider Name (Legal Business Name): MCNICHOLAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12828 W LASALLE ST STE 101
BOISE ID
83713-1517
US

IV. Provider business mailing address

12828 W LASALLE ST STE 101
BOISE ID
83713-1517
US

V. Phone/Fax

Practice location:
  • Phone: 623-670-1625
  • Fax: 208-579-5662
Mailing address:
  • Phone: 208-579-7400
  • Fax: 208-579-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES M. MCNICHOLAS
Title or Position: MANAGING MEMBER
Credential:
Phone: 623-670-1625