# MOUNTAIN STATES ONCOLOGY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205093739
- **Authorized official:** JONI SULLIVAN (BUSINESS ADMINISTRATOR)
- **Authorized official phone:** (208) 343-3223

## Contact information

- **Practice address:** 210 W JEFFERSON ST, BOISE, ID 83702-6044
- **Practice address phone:** (208) 343-3223
- **Practice address fax:** (208) 343-3263
- **Mailing address:** PO BOX 1809, BOISE, ID 83701-1809
- **Mailing address phone:** (208) 343-3223
- **Mailing address fax:** (208) 343-3263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/21/2008
- **Last updated:** 05/21/2008