Provider Demographics
NPI:1124674437
Name:MICHAEL J. MOORHOUSE INC.
Entity type:Organization
Organization Name:MICHAEL J. MOORHOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-938-2992
Mailing Address - Street 1:13900 W WAINWRIGHT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5028
Mailing Address - Country:US
Mailing Address - Phone:208-938-2992
Mailing Address - Fax:208-938-3476
Practice Address - Street 1:13900 W WAINWRIGHT DR STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5028
Practice Address - Country:US
Practice Address - Phone:208-938-2992
Practice Address - Fax:208-938-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHIA-1109OtherLISCENSE