MEDICARE: NORTH END PSYCHIATRY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1720586969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH END PSYCHIATRY

Provider Business Mailing Address
First Line	:	1423 W FRANKLIN ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5024
Country	:	US
Telephone Number	:	208-345-2212
Fax Number	:	208-345-2282

Provider Business Practice Location Address
First Line	:	1423 W FRANKLIN ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-5024
Country	:	US
Telephone Number	:	208-345-2212
Fax Number	:	208-345-2282

Authorized Official
Title or Position	:	MEMBER
Name	:	RICHARD A MONTGOMERY
Credential	:	MD
Telephone Number	:	208-345-2212

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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Directions to “NORTH END PSYCHIATRY ” Practice Location

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