# SAINT ALPHONSUS PHYSICIAN SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Saint Alphonsus Medical Group Shoreline
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073559449
- **Authorized official:** MS. JANELLE G. REILLY (PRESIDENT)
- **Authorized official phone:** (208) 367-6490

## Contact information

- **Practice address:** 1673 SHORELINE DRIVE, SUITE 120, BOISE, ID 83702-6749
- **Practice address phone:** (208) 429-8311
- **Practice address fax:** (208) 429-8310
- **Mailing address:** 3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
- **Mailing address phone:** (208) 367-5170
- **Mailing address fax:** (208) 367-5180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/22/2006
- **Last updated:** 12/24/2007