Idaho State University

LBN: Idaho State University
Idaho State University is an health care organization with primary practice located at 2033 E Summersweet Dr , Boise ID 83716-6695. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Idaho State University can be contacted via phone (208) 331-0182, or through Freeman, Tina M via phone (208) 331-0182.

Contact Information

Primary practice address
2033 E Summersweet Dr Boise ID 83716-6695
Phone: (208) 331-0182
Fax: (208) 331-0184
Website:
Map and Directions
Authorized official contact:
Name: Freeman, Tina M BHSA
Phone: (208) 331-0182

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X D-1819 Idaho

Profile Details

NPI number 1912110164
LBN Legal business name Idaho State University
DBA Doing business as
Authorized official Freeman, Tina M BHSA
Entity Organization
Organization subpart 1 No
Enumeration date May 7th, 2007
Last updated Jun 24th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912110164 NPPES
Idaho MEDICAID 807200600

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