Organization
HUMPHREYS DIABETES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT W SCANLON (EXECUTIVE DIRECTOR)
(208) 331-1155
Entity
Organization
Contact information
Practice address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
(208) 383-0190
Mailing address
1226 W RIVER ST, BOISE, ID 83702-7049
(208) 331-1155
(208) 383-0190
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY331
ID
133V00000X
Registered Dietitian
Primary
D33630
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1374744
MEDICARE MNT
ID
05
—
806348400
—
ID
01
—
8G502
BLUE CROSS
ID
Enumeration date
04/28/2008
Last updated
11/21/2008
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