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Organization

BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC

Active
Other names
Kaniksu Community Health
Organization subpart
No

Provider details

NPI number
Authorized official
KEVIN KNEPPER (CHIEF EXECUTIVE OFFICER)
(208) 263-3410
Entity
Organization

Contact information

Practice address
6615 COMANCHE ST, BONNERS FERRY, ID 83805
(208) 267-1718
(208) 267-7739
Mailing address
PO BOX 2160, SANDPOINT, ID 83864-0908
(208) 263-3410

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010142695
REGENCE OF IDAHO GROUP
ID
01
0176255
WA LABOR AND INDUSTRY
WA
01
131822
MEDICARE FQHC
05
806590100
ID
01
806591800
HEALTHY CONNECTIONS
ID
01
807823200
HEALTHY CONNECTIONS
ID
01
8905326
WA L AND I CRIME VICTIMS
WA
01
8H104
BLUE CROSS OF IDAHO GROUP
ID
01
DB1056
RAILROAD MEDICARE
Enumeration date
05/31/2006
Last updated
12/03/2021
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