Organization · Type 2 NPI

Boise State University

Community Health Clinic/Center · Boise, ID

NPI number 1134905243 Active

Practice location

2100 University Dr Ste 107
Boise, ID 83725-0001

Call (208) 426-1523 Map

Fax (208) 426-2302

Mailing address

1910 University Dr, # Ms 1855
Boise, ID 83725

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician	207Q00000X	None listed
Public Health & General Preventive Medicine Physician	2083P0901X	None listed
Public Health or Welfare Agency	251K00000X	None listed
Community Health Clinic/Center Primary	261QC1500X	None listed

Community Health Clinic/Center: Definition to come...

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NPI record

NPI: 1134905243
Entity type: Organization (Type 2)
Issued: Sep 5, 2023
Last updated: Aug 29, 2024
Status: Active

Other names

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Boise State University Public Health Clinic · doing business as
Boise State University Public Health Clinic · doing business as

Authorized official

Dr. Stephanie Hudon, PhD
Clinical Program Director
(208) 995-3765

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1134905243

Boise State University's National Provider Identifier is 1134905243, issued on Sep 5, 2023. The primary taxonomy on file is Community Health Clinic/Center (261QC1500X), and the practice location is in Boise, ID. The record was last updated on Aug 29, 2024.