Healthcare Provider Details

I. General information

NPI: 1093952947
Provider Name (Legal Business Name): INJURY CARE EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 N ROSEPOINT WAY STE 100
BOISE ID
83713-5262
US

IV. Provider business mailing address

4850 N ROSEPOINT WAY STE 100
BOISE ID
83713-5262
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-2100
  • Fax: 208-939-4411
Mailing address:
  • Phone: 208-939-2100
  • Fax: 208-939-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: RICHARD RADNOVICH
Title or Position: PARTNER
Credential: D.O.
Phone: 208-939-2100