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General NPI Number Information
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NPI Number | 1124674437
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Entity Type | Organization
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Legal Business Name | MICHAEL J. MOORHOUSE INC.
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 13900 W WAINWRIGHT DR STE 100
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City | BOISE
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State | ID
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Zip | 83713-5028
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Country | US
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Telephone | 208-938-2992
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Fax | 208-938-3476
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Provider Business Mailing Address
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Address Line | 13900 W WAINWRIGHT DR STE 100
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City | BOISE
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State | ID
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Zip | 83713-5028
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Country | US
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Telephone | 208-938-2992
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Fax | 208-938-3476
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | MR. MICHAEL MOORHOUSE
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Credential | MD
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Telephone | 208-938-2992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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