Provider Demographics
NPI:1780014753
Name:BOISE WOMENS HEALTH & BIRTH CENTER
Entity Type:Organization
Organization Name:BOISE WOMENS HEALTH & BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:208-639-2700
Mailing Address - Street 1:1502 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4028
Mailing Address - Country:US
Mailing Address - Phone:208-639-2700
Mailing Address - Fax:208-639-2736
Practice Address - Street 1:1502 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4028
Practice Address - Country:US
Practice Address - Phone:208-639-2700
Practice Address - Fax:208-639-2736
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOISE WOMEN'S HEALTH & BIRTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-12
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing