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Organization
THE PEDIATRIC AND ADOLESCENT CENTER, INC.
Active
Organization
THE PEDIATRIC AND ADOLESCENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM SULLIVAN BOURQUARD M.D (OWNER)
(208) 322-5437
Entity
Organization
Contact information
Practice address
6148 N DISCOVERY WAY, SUITE 100, BOISE, ID 83713-0201
(208) 322-5437
(208) 322-6013
Mailing address
6148 N DISCOVERY WAY, SUITE 100, BOISE, ID 83713-0201
(208) 322-5437
(208) 322-6013
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
M-5223
ID
Other
Enumeration date
04/02/2007
Last updated
08/22/2020
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