Healthcare Provider Details

I. General information

NPI: 1942782735
Provider Name (Legal Business Name): IDAHO SLEEP SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S 11TH ST STE 210
BOISE ID
83702-6968
US

IV. Provider business mailing address

PO BOX 9589
BOISE ID
83707-4589
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-0411
  • Fax: 208-895-0406
Mailing address:
  • Phone: 208-472-8107
  • Fax: 208-472-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRETT TROYER
Title or Position: OWNER
Credential: MD
Phone: 208-895-0411