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NPI Code Detail

MEDICARE: JOEL J BURCH PA

MEDICARE: JOEL J BURCH PA
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
1363AM0700XMedical Physician AssistantPA-1066ID

General Provider Information

NPI Number : 1679918536
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL J BURCH PA
Provider Business Mailing Address
First Line : PO BOX 191050
Second Line :
City : BOISE
State : ID
Zip : 83719-1050
Country : US
Telephone Number : 208-955-6500
Fax Number : 208-955-6503
Provider Business Practice Location Address
First Line : 1375 N HAPPY VALLEY RD
Second Line :
City : NAMPA
State : ID
Zip : 83687-5280
Country : US
Telephone Number : 208-809-2869
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2013
Last Update Date : 07/30/2020

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