Organization
MOUNTAIN STATES ONCOLOGY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONI SULLIVAN (BUSINESS ADMINSTRATOR)
(208) 343-3223
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6223
(208) 343-3223
Mailing address
PO BOX 1809, BOISE, ID 83701-1809
(208) 343-3223
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/21/2006
Last updated
08/22/2020
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