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General NPI Number Information
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NPI Number | 1003140724
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Entity Type | Organization
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Legal Business Name | PREMIUM SUPPORT SERVICES INC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 6568 S FEDERAL WAY STE 311
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City | BOISE
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State | ID
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Zip | 83716-9277
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Country | US
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Telephone | 208-284-0337
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Fax |
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Provider Business Mailing Address
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Address Line | 6568 S FEDERAL WAY STE 311
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City | BOISE
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State | ID
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Zip | 83716-9277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL RUMORE
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Credential |
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Telephone | 208-284-0337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M5928
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License Number State | ID
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