Organization
IDAHO NEPHROLOGY ASSOCIATES, L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEAL J ADCOX M.D. (MANAGING PARTNER)
(208) 367-3370
Entity
Organization
Contact information
Practice address
5610 GAGE ST, SUITE A, BOISE, ID 83706-1349
(208) 367-3370
(208) 367-3003
Mailing address
5610 GAGE ST, SUITE A, BOISE, ID 83706-1349
(208) 367-3370
(208) 367-3003
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006436
BLUE SHIELD OF IDAHO
ID
01
—
8A133
BLUE CROSS OF IDAHO
ID
01
—
CD6921
RR MEDICARE
ID
Enumeration date
07/27/2006
Last updated
01/08/2008
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