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NPI Code Detail

MEDICARE: PHILLIP IMPERIO

MEDICARE: PHILLIP IMPERIO
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 Assistant

General Provider Information

NPI Number : 1790504959
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP IMPERIO
Provider Business Mailing Address
First Line : 633 N 4TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4510
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 633 N 4TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4510
Country : US
Telephone Number : 208-342-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2024
Last Update Date : 05/13/2025

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Directions to “ PHILLIP IMPERIO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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