Organization
PAIN CARE CLINIC OF IDAHO, P.C.
Active
Organization
PAIN CARE CLINIC OF IDAHO, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDMUND C BOESE MD (OWNER)
(208) 939-3750
Entity
Organization
Contact information
Practice address
742 E STATE ST, SUITE 150, EAGLE, ID 83616-5941
(208) 939-3750
(208) 939-3754
Mailing address
742 E STATE ST, SIUITE 150, EAGLE, ID 83616-5941
(208) 939-3750
(208) 939-3754
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
M12565
ID
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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