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Contact Information

STATE OF IDAHO
120 S COLE RD
SUITE 120 - BLDG 3
BOISE, ID83709-0932
 Phone: 208-334-3220
 Fax: 208-334-2963
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Low Vision Rehabilitation

152WL0500X 41 Optometry
Indicates primary specialty

NPI Profile & details for STATE OF IDAHO

NPI # 1801833454
LBN Legal business name STATE OF IDAHO
Authorized official ANGELA ROAN - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 06/01/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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