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General NPI Number Information
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NPI Number | 1316549116
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Entity Type | Organization
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Legal Business Name | BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 30410 HIGHWAY 200
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City | PONDERAY
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State | ID
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Zip | 83852-9601
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Country | US
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Telephone | 208-265-6252
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2160
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City | SANDPOINT
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State | ID
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Zip | 83864-0908
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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 | KEVIN KNEPPER
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Credential |
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Telephone | 208-263-3410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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