Organization
PEDIATRIC NEUROSURGRY OF IDAHO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER BRUCE CHERNY MD (OWNER)
(208) 381-7360
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6270
(208) 381-7360
(208) 381-7361
Mailing address
6140 CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 367-3500
(208) 367-3500
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M8385
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8M819
BLUE CROSS OF IDAHO GROUP
—
Enumeration date
05/26/2006
Last updated
05/26/2008
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