Basic Information
| Provider Information | |||||||||
| NPI: | 1902963101 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOISE KIDNEY & HYPERTENSION PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 E LOUISE DR STE 195 | ||||||||
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| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836426303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088468335 | ||||||||
| FaxNumber: | 2088468336 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 E LOUISE DR STE 195 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088468335 | ||||||||
| FaxNumber: | 2088468336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | SILVA | ||||||||
| AuthorizedOfficialFirstName: | ARNOLD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2088468335 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1902963101 | 05 | ID | MEDICAID |