Organization
BOISE RADIOLOGY GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA SMITH (ADMINISTRATOR)
(208) 433-9466
Entity
Organization
Contact information
Practice address
620 W HAYS ST, BOISE, ID 83702-5511
(208) 381-2094
(208) 381-1791
Mailing address
PO BOX 1616, EVANSVILLE, IN 47706-0018
(208) 381-2094
(208) 381-1791
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Enumeration date
06/25/2006
Last updated
03/04/2024
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