Provider Demographics
NPI:1174671481
Name:SPECIALTY CLINICS OF IDAHO INC
Entity Type:Organization
Organization Name:SPECIALTY CLINICS OF IDAHO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-433-9300
Mailing Address - Street 1:3085 E MAGIC VIEW DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3745
Mailing Address - Country:US
Mailing Address - Phone:208-433-9300
Mailing Address - Fax:208-433-9854
Practice Address - Street 1:3085 E MAGIC VIEW DR STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3745
Practice Address - Country:US
Practice Address - Phone:208-433-9300
Practice Address - Fax:208-433-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty