Healthcare Provider Details

I. General information

NPI: 1194908053
Provider Name (Legal Business Name): BOISE INTENSIVE CARE HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 SOUTH BONITO WAY
MERIDIAN ID
83642-1659
US

IV. Provider business mailing address

5340 LEGACY DR SUITE 150
PLANO TX
75024-3178
US

V. Phone/Fax

Practice location:
  • Phone: 866-599-9925
  • Fax:
Mailing address:
  • Phone: 469-241-2100
  • Fax: 469-241-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CRONIN
Title or Position: VICE PRESIDENT OF REIMBURSEMENT
Credential: CPA
Phone: 469-241-2128