Provider Demographics
NPI:1689775207
Name:WOMAN'S CLINIC
Entity Type:Organization
Organization Name:WOMAN'S CLINIC
Other - Org Name:THE WOMAN'S CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-345-5250
Mailing Address - Street 1:100 E IDAHO ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6223
Mailing Address - Country:US
Mailing Address - Phone:208-345-5250
Mailing Address - Fax:208-345-2364
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:SUITE 3209
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6308
Practice Address - Country:US
Practice Address - Phone:208-884-3980
Practice Address - Fax:208-884-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1370115Medicare ID - Type Unspecified
ID1370116Medicare ID - Type Unspecified