Healthcare Provider Details

I. General information

NPI: 1619998648
Provider Name (Legal Business Name): PAIN CARE CENTER BOISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MYRTLE ST
BOISE ID
83702-7656
US

IV. Provider business mailing address

301 W MYRTLE ST
BOISE ID
83702-7656
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-8200
  • Fax: 208-343-8202
Mailing address:
  • Phone: 208-342-8200
  • Fax: 208-342-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM G BINEGAR
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 208-342-8200