Boise Basin Infertility & Gynecology, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

M-3549 Issued in ID

Legal business name

BOISE BASIN INFERTILITY & GYNECOLOGY, P.A.

Practice address

811 N 6TH St
Boise, ID 83702-5545

Phone

(208) 345-2006

Fax

(208) 345-1408

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Philip M Krueger

Title

President

Phone

(208) 345-2006

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1831285857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 N 6TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025545",
            "telephone_number": "208-345-2006",
            "fax_number": "208-345-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 N 6TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025545",
            "telephone_number": "208-345-2006",
            "fax_number": "208-345-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE BASIN INFERTILITY & GYNECOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-345-2006"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-3549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002515100",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002515101",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "DK093",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010004456",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002515102",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Boise, ID
• Providers in Boise, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.