Organization
SAINT ALPHONSUS NEPHROLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN M JACOBS (ACCOUNTS RECEIVABLE MANAGER)
(208) 367-3076
Entity
Organization
Contact information
Practice address
515 EAST LN, ONTARIO, OR 97914-3953
(541) 889-9557
(541) 881-8721
Mailing address
5610 GAGE ST, STE B, BOISE, ID 83706-1349
(208) 367-3076
(208) 367-6909
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
170009
OR
Other
Enumeration date
11/02/2005
Last updated
08/22/2020
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