Healthcare Provider Details

I. General information

NPI: 1699943332
Provider Name (Legal Business Name): IDAHO SLEEP SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W GEORGIA
NAMPA ID
83686
US

IV. Provider business mailing address

7272 POTOMAC DR.
BOISE ID
83704
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-8222
  • Fax: 208-375-8232
Mailing address:
  • Phone: 208-375-8222
  • Fax: 208-375-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberW53339
License Number StateID

VIII. Authorized Official

Name: DONALD J BEASLEY
Title or Position: MANAGER
Credential: MD
Phone: 208-463-3000