Provider Demographics
NPI:1689332959
Name:BOISE ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:BOISE ENDOSCOPY CENTER, LLC
Other - Org Name:CANYON COUNTY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-489-1431
Mailing Address - Street 1:2235 E GALA ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8026
Mailing Address - Country:US
Mailing Address - Phone:208-489-1431
Mailing Address - Fax:208-343-5031
Practice Address - Street 1:1216 GARRITY BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3402
Practice Address - Country:US
Practice Address - Phone:208-954-8218
Practice Address - Fax:208-368-0863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOISE ENDOSCOPY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-03
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical