Healthcare Provider Details

I. General information

NPI: 1366492084
Provider Name (Legal Business Name): SAINT ALPHONSUS PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GARRITY BLVD
NAMPA ID
83687-3402
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-9092
  • Fax: 208-466-5322
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JANELLE G. REILLY
Title or Position: PRESIDENT
Credential:
Phone: 208-367-6490