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Organization
SOUTHWEST DISTRICT HEALTH
Active
Organization
SOUTHWEST DISTRICT HEALTH
Active
Other names
State of Idaho
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY S BOSTER (OFFICE SPECIALIST II)
(208) 455-5348
Entity
Organization
Contact information
Practice address
13307 MIAMI LN, CALDWELL, ID 83607-4701
(208) 455-5305
(208) 455-5368
Mailing address
13307 MIAMI LN, CALDWELL, ID 83607-4701
(208) 455-5305
(208) 455-5368
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
251K00000X
Public Health or Welfare Agency
Primary
—
NULL
Other
Enumeration date
11/25/2005
Last updated
02/02/2024
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