Healthcare Provider Details

I. General information

NPI: 1841301934
Provider Name (Legal Business Name): OSTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S 11TH ST
BOISE ID
83702-6968
US

IV. Provider business mailing address

403 S 11TH ST
BOISE ID
83702-6968
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-3261
  • Fax: 208-342-2263
Mailing address:
  • Phone: 208-344-3261
  • Fax: 208-342-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberM7900
License Number StateID

VIII. Authorized Official

Name: DAVID OSTER
Title or Position: CEO
Credential:
Phone: 208-344-3261