Organization
IDAHO CENTER FOR REPRODUCTIVE MEDICINE PC
Active
Other names
ICRM PC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GENIE T ANDREWS (BUS ADMIN)
(208) 342-5900
Entity
Organization
Contact information
Practice address
111 MAIN ST, SUITE 100, BOISE, ID 83702-7307
(208) 342-5900
(208) 342-2088
Mailing address
111 MAIN ST, SUITE 100, BOISE, ID 83702-7307
(208) 342-5900
(208) 342-2088
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
M7577
ID
207VE0102X
Reproductive Endocrinology Physician
M8614
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51292
BLUE CROSS DR SLATER
ID
01
—
513CO
BLUE CROSS DR FOULK
ID
01
—
8G189
BLUE CROSS CLINIC
ID
Enumeration date
02/05/2007
Last updated
08/22/2020
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