# IDAHO PEDIATRIC GASTROENTEROLOGY PA

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

## Provider details

- **NPI number:** 1780871467
- **Authorized official:** MR. HENRY R THOMPSON MD (PRESIDENT)
- **Authorized official phone:** (208) 381-7310

## Contact information

- **Practice address:** 100 E IDAHO ST, SUITE 316, BOISE, ID 83712-6223
- **Practice address phone:** (208) 381-7310
- **Mailing address:** 100 E IDAHO ST, SUITE 316, BOISE, ID 83712-6223
- **Mailing address phone:** (208) 381-7310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M7673 | ID | Yes |

## Other

- **Enumeration date:** 09/26/2007
- **Last updated:** 09/26/2007