Organization
IDAHO DEPT OF HEALTH & WELFARE ITP REGION 4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY J JONES B.U.S. (PROGRAM MANAGER)
(208) 334-5523
Entity
Organization
Contact information
Practice address
1720 WESTGATE DR, SUITE B-2, BOISE, ID 83704-7164
(208) 334-0900
(208) 334-0926
Mailing address
1720 WESTGATE DR, SUITE B-2, BOISE, ID 83704-7164
(208) 334-0900
(208) 334-0926
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010019044
BLUE SHIELD
ID
05
—
0028406
—
ID
01
—
HW306
BLUE CROSS OF IDAHO
ID
Enumeration date
02/08/2007
Last updated
08/05/2013
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us