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General NPI Number Information
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NPI Number | 1063360832
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Entity Type | Individual
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Provider Name | JEREMY E. RICKY
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Gender | Male
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 1111 S ORCHARD ST STE 219
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City | BOISE
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State | ID
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Zip | 83705-1922
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Country | US
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Telephone | 208-999-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 721 S WOODHAVEN AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-3540
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Country | US
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Telephone | 208-999-1770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State | ID
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