Healthcare Provider Details

I. General information

NPI: 1699703371
Provider Name (Legal Business Name): SAINT ALPHONSUS PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6533 W EMERALD ST
BOISE ID
83704-8737
US

IV. Provider business mailing address

6533 W EMERALD ST
BOISE ID
83704-8737
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-4197
  • Fax: 208-367-8136
Mailing address:
  • Phone: 208-367-4197
  • Fax: 208-367-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateID

VIII. Authorized Official

Name: MR. STEPHEN G FRANEY
Title or Position: CEO
Credential:
Phone: 208-367-7270