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Contact Information

BEACON PAIN CLINIC
115 W MAIN ST
102
BOISE, ID83702-7302
 Phone: 208-342-2104
 Fax: 208-342-4710
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for BEACON PAIN CLINIC · (Female)

NPI # 1477941672
Status Active
Credentials
Entity Individual
Enumeration date 12/23/2014
Last updated 12/23/2014 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers
  • ID License # M9987
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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