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NPI Code Detail

MEDICARE: STEPHEN BURGESS

MEDICARE: STEPHEN BURGESS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1184581233
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN BURGESS
Provider Business Mailing Address
First Line : 2897 S ZIMS AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-9147
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1276 W RIVER ST STE 100
Second Line :
City : BOISE
State : ID
Zip : 83702-7083
Country : US
Telephone Number : 208-760-6981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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Directions to “ STEPHEN BURGESS ” Practice Location

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