Provider Demographics
NPI:1598789950
Name:IDAHO NEPHROLOGY ASSOCIATES, L.L.C
Entity Type:Organization
Organization Name:IDAHO NEPHROLOGY ASSOCIATES, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-367-3370
Mailing Address - Street 1:5610 GAGE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1349
Mailing Address - Country:US
Mailing Address - Phone:208-367-3370
Mailing Address - Fax:208-367-3003
Practice Address - Street 1:5610 GAGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1349
Practice Address - Country:US
Practice Address - Phone:208-367-3370
Practice Address - Fax:208-367-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCD6921OtherRR MEDICARE
ID000010006436OtherBLUE SHIELD OF IDAHO
ID8A133OtherBLUE CROSS OF IDAHO
ID000010006436OtherBLUE SHIELD OF IDAHO
ID8A133OtherBLUE CROSS OF IDAHO