Provider Demographics
NPI:1801345467
Name:INTEGRATIVE PALLIATIVE CARE, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE PALLIATIVE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-473-1348
Mailing Address - Street 1:1015 W HAYS ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5424
Mailing Address - Country:US
Mailing Address - Phone:208-473-1348
Mailing Address - Fax:
Practice Address - Street 1:1015 W HAYS ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5424
Practice Address - Country:US
Practice Address - Phone:208-473-1348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5398251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1568500700Medicaid
ID1568500700Medicaid