Organization
BOISE ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LOCKWOOD MD (AUTHORIZED OFFICIAL)
(208) 342-7169
Entity
Organization
Contact information
Practice address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 342-7169
(208) 368-0863
Mailing address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 342-7169
(208) 343-5031
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1870273
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005291
BLUE SHIELD OF IDAHO
ID
01
—
04580
BLUE CROSS OF IDAHO
ID
05
—
805944300
—
ID
Enumeration date
09/15/2005
Last updated
04/18/2026
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