Provider Demographics
NPI:1700456274
Name:PERIPHERAL VASCULAR PARTNERS OF BOISE
Entity Type:Organization
Organization Name:PERIPHERAL VASCULAR PARTNERS OF BOISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-492-4064
Mailing Address - Street 1:5131 S 1500 W
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3926
Mailing Address - Country:US
Mailing Address - Phone:385-492-4064
Mailing Address - Fax:801-689-3277
Practice Address - Street 1:3581 E OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6757
Practice Address - Country:US
Practice Address - Phone:385-492-4064
Practice Address - Fax:801-689-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty