Center for Colorectal Care, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

M9825 Issued in ID

Legal business name

CENTER FOR COLORECTAL CARE, LLC

Practice address

333 N 1St St
Suite 130
Boise, ID 83702-6100

Phone

(770) 823-1668

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

James A Olson, MD

Title

Manager

Phone

(770) 823-1668

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740319409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N 1ST ST",
            "address_2": "SUITE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N 1ST ST",
            "address_2": "SUITE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026100",
            "telephone_number": "770-823-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR COLORECTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-823-1668",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "ID",
            "license": "M9825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.