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Organization
IDAHO SPORTS MEDICINE INSTITUTE PA
Active
Organization
IDAHO SPORTS MEDICINE INSTITUTE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER R. MILLIER M.D. (OWNER/PARTNER)
(208) 336-8250
Entity
Organization
Contact information
Practice address
1188 UNIVERSITY DR, BOISE, ID 83706-3009
(208) 336-8250
(208) 345-9514
Mailing address
1188 W UNIVERSITY DR, BOISE, ID 83706-3009
(208) 336-8250
(208) 345-9514
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
N/A FOR GROUP
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805993900
—
ID
01
—
8628-0
BLUE CROSS OF IDAHO GROUP
ID
01
—
REGENCE BLUE SHIELD
GROUP # 29145
ID
Enumeration date
07/12/2006
Last updated
01/06/2026
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