=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548762867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENTS OF THE UNIVERSITY OF IDAHO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2018
-----------------------------------------------------
Last Update Date | 01/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 831 ASH ST
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83844-9803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-885-2210
-----------------------------------------------------
Fax | 208-885-1002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 875 PERIMETER DR # MS 4201
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83844-9803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-885-6693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EHR AND POLICY MANAGER
-----------------------------------------------------
Name | AARON PAPIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-885-6693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------