Boundary Regional Community Health Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.

Doing business as

Kaniksu Health Services

Practice address

6635 Comanche St
Bonners Ferry, ID 83805-7523

Phone

(208) 267-1718

Fax

(208) 267-7739

NPI assigned

Dec 29, 2006

Organization subpart

No

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

Authorized official

Name

Vicki McClellan

Title

Chief Executive Officer

Phone

(208) 267-1718

Specialties & licenses 1

Addresses

Other names 1

• Kaniksu Health Services Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 131828

Legal name

BOUNDARY REGIONAL COMMUNITY HEALTH - MOBILE UNIT 1

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 2, 2005

Last certification

Sep 2, 2005

Ownership / control type

For profit – corporation

Facility address

6635 Comanche Street
Bonners Ferry, ID 83805

Locations

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1770649154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6635 COMANCHE ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057523",
            "telephone_number": "208-267-1718",
            "fax_number": "208-267-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6635 COMANCHE ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057523",
            "telephone_number": "208-267-1718",
            "fax_number": "208-267-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "MCCLELLAN",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "208-267-1718"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kaniksu Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Boundary County Community Restorium
• Boundary County School District #101
• Boundary Regional Community Health Center Inc
• Boundary Regional Community Health Center, Inc.
• Boundary Regional Community Health Center, Inc.
• Boundary Volunteer Ambulance Service Inc.
• Alicia Braden, LMP
• Madeline Brown
• John Pierce Brownlee Jr., CRNA
• Sherry Lee Bushnell, FNP

• Federally Qualified Health Center (FQHC) in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Federally Qualified Health Center (FQHC) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.