NPIMap

Organization Active NPI

Boise Ultrasound Company LLP

  • Radiology Clinic/Center
  • Boise, ID
National Provider Identifier
1245824929
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
BOISE ULTRASOUND COMPANY LLP
Practice address
1510 S Robert St Ste 101
Boise, ID 83705-5194
Phone
(208) 902-2620
Fax
(208) 408-0280
NPI assigned
Feb 23, 2021
Last updated
Jan 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lacy Marlatt
Title
Owner/Partner
Phone
(208) 902-2620

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Ultrasound PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085U0001X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

1510 S Robert St Ste 101
Boise, ID 83705-5194

Mailing address

1510 S Robert St Ste 101
Boise, ID 83705-5194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210713001098 ID Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7416359542 Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

1510 S Robert St
Boise, ID 83705

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1245824929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S ROBERT ST STE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837055194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S ROBERT ST STE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837055194",
            "telephone_number": "208-902-2620",
            "fax_number": "208-408-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE ULTRASOUND COMPANY LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-23",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "MARLATT",
        "authorized_official_first_name": "LACY",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "208-902-2620"
    },
    "taxonomies": [
        {
            "code": "2085U0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.