MEDICARE: FULL CIRCLE HEALTH, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841490075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE HEALTH, INC.

Provider Business Mailing Address
First Line	:	777 N RAYMOND ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9251
Country	:	US
Telephone Number	:	208-514-2500
Fax Number	:	208-375-2217

Provider Business Practice Location Address
First Line	:	777 N RAYMOND ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704
Country	:	US
Telephone Number	:	208-514-2500
Fax Number	:	208-375-2217

Authorized Official
Title or Position	:	DIRECTOR OF MEDICAL STAFF OFFICE
Name	:	SUZETTE N ANSAY
Credential	:	CPCS
Telephone Number	:	208-954-8746

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	03/05/2026

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Directions to “FULL CIRCLE HEALTH, INC. ” Practice Location

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