Organization
N S SUPPORT LLC
Active
Other names
NeuroScience Associates
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY REDIKER (CREDENTIALING SPECIALIST)
(208) 327-5631
Entity
Organization
Contact information
Practice address
6140 W CURTISIAN AVE, SUITE 400, BOISE, ID 83704
(208) 367-3500
(208) 367-3500
Mailing address
6140 W CURTISIAN AVE STE 400, BOISE, ID 83704-8907
(208) 327-5600
(208) 327-5602
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006153
DMAP
—
01
—
8J190
BLUE CROSS OF IDAHO GROUP
ID
Enumeration date
08/06/2006
Last updated
02/23/2021
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