NPIMap

Organization Active NPI

Boise State University

  • Clinical Medical Laboratory
  • Boise, ID
National Provider Identifier
1770183089
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
BOISE STATE UNIVERSITY
Practice address
2133 W Cesar Chavez LN RM 239
Boise, ID 83725-0001
Phone
(208) 426-1038
NPI assigned
Oct 27, 2020
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Dr. Stephanie Hudon, PHD
Title
Clinical Lab Manager
Phone
(208) 995-3765

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X NU
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

2133 W Cesar Chavez LN RM 239
Boise, ID 83725-0001

Mailing address

1910 University Dr # Ms 1515
Boise, ID 83725-0002
Phone (208) 426-1038

Other practice location 1

2100 W University Dr Room 109
Boise, ID 83725-0001
Phone (208) 426-1523

Other practice location 2

2100 W University Dr Room 1007
Boise, ID 83725-0001
Phone (208) 426-2969

Other names 1

  • Boise State University Clinical Laboratory Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210329002526 ID Part B Supplier - Independent Clinical Laboratory 5991112468 Practice locations: Boise, ID

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2193886Boise State Genetics and Infectious Disease2133 W Cesar Chavez Way, Boise, ID 83725ComplianceFeb 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Boise State University3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1910 University Dr
Boise, ID 83725
Phone (208) 426-1000

1910 University Dr
#1515
Boise, ID 83725

2100 W University Dr
Rm 1007
Boise, ID 83725
Phone (208) 426-2969

2100 W University Dr
Rm 109
Boise, ID 83725
Phone (208) 426-1523

2133 W Cesar Chavez Ln
Boise, ID 83725
Phone (208) 426-1038

2133 W Cesar Chavez Ln
Rm 239
Boise, ID 83725
Phone (208) 426-1038

Bsu Science Bld
Rm 239 2133 W CESAR CHAVEZ LN
Boise, ID 83725

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1770183089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 UNIVERSITY DR # MS 1515",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837250002",
            "telephone_number": "208-426-1038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 W CESAR CHAVEZ LN RM 239",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837250001",
            "telephone_number": "208-426-1038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 W University Dr Room 109",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837250001",
            "country_code": "US",
            "telephone_number": "208-426-1523",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2100 W University Dr Room 1007",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837250001",
            "country_code": "US",
            "telephone_number": "208-426-2969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOISE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2023-10-12",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "HUDON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CLINICAL LAB MANAGER",
        "authorized_official_telephone_number": "208-995-3765",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boise State University Clinical Laboratory",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Boise State University Clinical Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.