Provider Demographics
NPI:1912905100
Name:REHAB SYSTEMS BOISE LLC
Entity Type:Organization
Organization Name:REHAB SYSTEMS BOISE LLC
Other - Org Name:COYOTE PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-342-4104
Mailing Address - Street 1:427 N CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1439
Mailing Address - Country:US
Mailing Address - Phone:208-342-4104
Mailing Address - Fax:208-342-4106
Practice Address - Street 1:427 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1439
Practice Address - Country:US
Practice Address - Phone:208-342-4104
Practice Address - Fax:208-342-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010147985OtherBLUE SHIELD OF IDAHO
ID8J604OtherBLUE CROSS OF IDAHO
ID002728201Medicaid
ID8J604OtherBLUE CROSS OF IDAHO