Healthcare Provider Details

I. General information

NPI: 1295500478
Provider Name (Legal Business Name): CAPITAL CITY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 W ELDER ST STE 209
BOISE ID
83705-4772
US

IV. Provider business mailing address

2742 N MCKINNEY ST
BOISE ID
83704-6022
US

V. Phone/Fax

Practice location:
  • Phone: 866-316-9062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA AHLERS
Title or Position: OWNER
Credential:
Phone: 866-316-9062