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General NPI Number Information
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NPI Number | 1225629074
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Entity Type | Organization
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Legal Business Name | IDAHO CLINIC
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 8854 W EMERALD ST STE 290
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City | BOISE
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State | ID
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Zip | 83704-4846
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Country | US
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Telephone | 208-287-9420
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 S BONITO WAY STE 190
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City | MERIDIAN
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State | ID
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Zip | 83642-5618
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Country | US
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Telephone | 208-287-9420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED ARMSTRONG
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Credential | MD
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Telephone | 206-300-8584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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