Healthcare Provider Details

I. General information

NPI: 1831663442
Provider Name (Legal Business Name): NOAH C CHANCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S TEN MILE RD
MERIDIAN ID
83642-6100
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2872
  • Fax: 208-809-2873
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2719
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: