Organization
DYNAMED INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER HUNT (PRESIDENT)
(208) 322-5055
Entity
Organization
Contact information
Practice address
1404 W IDAHO ST, BOISE, ID 83702-5245
(208) 322-5055
(208) 322-8033
Mailing address
1404 W IDAHO ST, BOISE, ID 83702-5210
(208) 322-5055
(208) 322-8033
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152453
REGENCE BCBS OF IDAHO
ID
Enumeration date
05/02/2006
Last updated
08/22/2020
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