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Organization
PARK CENTER FOOT AND ANKLE
Active
Organization
PARK CENTER FOOT AND ANKLE
Active
Other names
Park Center Foot & Ankle Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ALYSSA BARBER (BILLER)
(208) 387-0900
Entity
Organization
Contact information
Practice address
671 E. RIVERPARK LANE, STE 110, BOISE, ID 83706
(208) 387-0900
(208) 345-5883
Mailing address
671 E. RIVERPARK LANE, STE 110, BOISE, ID 83706
(208) 387-0900
(208) 345-5883
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P142
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015660
REGENCE BS OF ID
ID
05
—
002725800
—
ID
01
—
DA8994
RAILROAD MEDICARE
—
01
—
P1423
BLUE CROSS OF ID
ID
Enumeration date
02/17/2006
Last updated
11/13/2023
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