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General NPI Number Information
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NPI Number | 1295680197
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Entity Type | Organization
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Legal Business Name | PURE INFUSION OF IDAHO LLC
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 5975 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83709-3012
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Country | US
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Telephone | 208-488-4998
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Fax |
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Provider Business Mailing Address
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Address Line | 75 W TOWNE RIDGE PKWY STE 500
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City | SANDY
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State | UT
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Zip | 84070-5531
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Country | US
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Telephone | 801-590-9267
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Fax |
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Authorized Official
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Title or Position | VP OF PAYER DEVELOPMENT
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Name | RACHEL FRAGA
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Credential |
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Telephone | 801-590-9267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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