Boise Dermaesthetics, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BOISE DERMAESTHETICS, LLC

Practice address

6126 W Emerald St
Boise, ID 83704-8857

Phone

(208) 323-6525

NPI assigned

Jun 4, 2006

Organization subpart

No

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

Authorized official

Name

Cheryl D Lundy

Title

Billing Manger

Phone

(208) 452-6794

Specialties & licenses 1

Addresses

Other names 1

• McConnehey Family Medicine Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brock McConnehey, DO

  • Family Medicine Physician
  • Boise, ID
  • NPI 1285672733
  NPD (past)
• Diane McConnehey, DO

  • Family Medicine Physician
  • Boise, ID
  • NPI 1558309526
  NPD (past)

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1639117153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6126 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048857",
            "telephone_number": "208-323-6525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6126 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048857",
            "telephone_number": "208-323-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE DERMAESTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "LUNDY",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING MANGER",
        "authorized_official_telephone_number": "208-452-6794"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McConnehey Family Medicine",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Boise Children'S Dentistry PLLC
• Boise Chiropractic Inc
• Boise Counseling and Wellness
• Boise Counseling Center, LLC
• Boise Dental Center
• Boise Dialysis Partners II, LLC
• Boise Endoscopy Center LLC
• Boise ENT, LLC
• Boise Family Center
• Boise Family Dental Care, PLLC

• Family Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.