Organization
THE PEDIATRIC AND ADOLESCENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM SULLIVAN BOURQUARD M.D (OWNER)
(208) 322-5437
Entity
Organization
Contact information
Practice address
6148 N DISCOVERY WAY, SUITE 100, BOISE, ID 83713-0201
(208) 322-5437
(208) 322-6013
Mailing address
6148 N DISCOVERY WAY, SUITE 100, BOISE, ID 83713-0201
(208) 322-5437
(208) 322-6013
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
M-5223
ID
Other
Enumeration date
04/02/2007
Last updated
08/22/2020
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