Organization
ID DEPT OF HEALTH & WELFARE CSHP (PKU FORM)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIGE FINCHER BSW (ACTING PROGRAM MANAGER)
(208) 334-4935
Entity
Organization
Contact information
Practice address
450 W STATE ST, 4TH FLOOR, BOISE, ID 83702-6056
(208) 334-4935
(208) 332-7307
Mailing address
PO BOX 83720, 4TH FLOOR, BOISE, ID 83720-0036
(208) 334-4935
(208) 332-7307
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010022948
BLUE SHIELD
ID
05
—
0028484
—
ID
01
—
HW207
BLUE CROSS OF ID
ID
Enumeration date
04/11/2007
Last updated
08/22/2020
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