Organization
BOISE STATE UNIVERSITY
Active
Organization
BOISE STATE UNIVERSITY
Active
Other names
Boise State University Public Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE HUDON PHD (CLINICAL PROGRAM DIRECTOR)
(208) 995-3765
Entity
Organization
Contact information
Practice address
2100 UNIVERSITY DR STE 107, BOISE, ID 83725-0001
(208) 426-1523
(208) 426-2302
Mailing address
1910 UNIVERSITY DR, # MS 1855, BOISE, ID 83725
(208) 426-1523
(208) 426-2302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
251K00000X
Public Health or Welfare Agency
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134905243
—
ID
Enumeration date
09/05/2023
Last updated
08/29/2024
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