Organization
IDAHO ADVANCED MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID COOPER (OWNER)
(818) 915-4545
Entity
Organization
Contact information
Practice address
13150 W PERSIMMON LN, BOISE, ID 83713-1986
(818) 915-4545
Mailing address
13150 W PERSIMMON LN, BOISE, ID 83713-1986
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/31/2022
Last updated
03/21/2022
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