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General NPI Number Information
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NPI Number | 1548114655
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Entity Type | Organization
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Legal Business Name | BOISE ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 875 S VANGUARD WAY STE 300
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City | MERIDIAN
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State | ID
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Zip | 83642-8613
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Country | US
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Telephone | 208-565-5035
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Fax | 208-343-5031
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Provider Business Mailing Address
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Address Line | 425 W BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83702-6035
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Country | US
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Telephone | 208-343-6458
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Fax | 208-343-5031
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT LOCKWOOD
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Credential | MD
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Telephone | 208-343-6458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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