Provider Demographics
NPI:1629609326
Name:BOISE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BOISE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIAZ HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-536-7268
Mailing Address - Street 1:7715 NW 48TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5473
Mailing Address - Country:US
Mailing Address - Phone:786-536-7268
Mailing Address - Fax:786-536-7608
Practice Address - Street 1:7715 NW 48TH ST STE 350
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5473
Practice Address - Country:US
Practice Address - Phone:786-536-7268
Practice Address - Fax:786-536-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty