Healthcare Provider Details

I. General information

NPI: 1740251925
Provider Name (Legal Business Name): ADA BOI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W MOSSY CUP ST
BOISE ID
83709-2844
US

IV. Provider business mailing address

PO BOX 190480
BOISE ID
83719-0480
US

V. Phone/Fax

Practice location:
  • Phone: 208-362-2973
  • Fax: 208-362-0854
Mailing address:
  • Phone: 208-362-2973
  • Fax: 208-362-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number8405
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8405
License Number StateID

VIII. Authorized Official

Name: MRS. KATHIE S FOGG
Title or Position: OFFICE MANAGER
Credential: EMT
Phone: 208-362-2973