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General NPI Number Information
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NPI Number | 1720423429
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Entity Type | Organization
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Legal Business Name | IDAHO NEUROLOGY PLLC
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 901 N CURTIS RD SUITE 101
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City | BOISE
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State | ID
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Zip | 83706-1338
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Country | US
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Telephone | 208-608-5825
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Fax | 208-287-3690
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Provider Business Mailing Address
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Address Line | 2825 FORT MISSOULA RD STE 121
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City | MISSOULA
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State | MT
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Zip | 59804-7403
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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 | OWNER
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Name | THOMAS SWANSON
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Credential | MD
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Telephone | 406-274-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | M11896
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License Number State | ID
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