MEDICARE: BOISE STATE HEALTH CENTER

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
1	261QS1000X	Student Health Clinic/Center	M-7056	ID

General Provider Information

NPI Number	:	1194865444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOISE STATE HEALTH CENTER

Provider Business Mailing Address
First Line	:	1910 UNIVERSITY DR # MS -1351
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83725-1351
Country	:	US
Telephone Number	:	208-426-2158
Fax Number	:	208-426-1448

Provider Business Practice Location Address
First Line	:	1529 BELMONT ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83725-1351
Country	:	US
Telephone Number	:	208-426-1459
Fax Number	:	208-426-3005

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROCHELLE WOLFE
Credential	:	MD
Telephone Number	:	208-426-1470

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/08/2020

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Directions to “BOISE STATE HEALTH CENTER ” Practice Location

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