Provider Demographics
NPI:1134210966
Name:BOISE RHEUMATOLOGY PC
Entity type:Organization
Organization Name:BOISE RHEUMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ECKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-433-0232
Mailing Address - Street 1:222 N 2ND ST
Mailing Address - Street 2:STE. 304
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6109
Mailing Address - Country:US
Mailing Address - Phone:208-433-0232
Mailing Address - Fax:208-433-0234
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:STE. 304
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6109
Practice Address - Country:US
Practice Address - Phone:208-433-0232
Practice Address - Fax:208-433-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8360207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1366071Medicare PIN
IDE74684Medicare UPIN