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Organization
BOISE STATE UNIVERSITY
Active
Organization
BOISE STATE UNIVERSITY
Active
Other names
Boise State University Public Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE HUDON PHD (CLINICAL PROGRAM DIRECTOR)
(208) 995-3765
Entity
Organization
Contact information
Practice address
2100 UNIVERSITY DR STE 107, BOISE, ID 83725-0001
(208) 426-1523
(208) 426-2302
Mailing address
1910 UNIVERSITY DR, # MS 1855, BOISE, ID 83725
(208) 426-1523
(208) 426-2302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
—
NULL
251K00000X
Public Health or Welfare Agency
—
NULL
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
09/05/2023
Last updated
08/29/2024
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