BOISE PODIATRY CLINIC, P. A. (NPI# 1982711578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982711578 |
| Entity Type | Organization |
| Organization Name | BOISE PODIATRY CLINIC, P. A. |
| Other Organization Name | PODIATRY CENTER OF IDAHO |
| Practice Address |
6051 N Eagle Rd Boise ID 83713 |
| Practice Telephone | 2089384670 |
| Practice Fax Number | 2089384675 |
| Mailing Telephone | 2089384670 |
| Mailing Fax Number | 2089384675 |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-12-11 |
| Authorized Official Name | DR. GARY J MILLWARD (ADMINISTRATOR) |
| Authorized Official Telephone | 2089384670 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| Podiatry Center of Idaho | Doing Business As Name - Organization |
| Street Address |
6051 N EAGLE RD |
| City | BOISE |
| State | ID |
| Zip Code | 83713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063462075 | Gary J Millward | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2006-05-11 |
| 1598271645 | Treasure Valley Dermatology & Skin Cancer Center, Pllc | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2017-12-26 |
| 1154870251 | Jacob Shane Tebbs | Physician Assistant | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2016-09-29 |
| 1588002547 | Dustin Ray Portela | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2013-06-11 |
| 1952628745 | Ryan J Harris | Dermatology | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2010-05-03 |
| 1407047202 | Mariya Rose Ostermiller | Physician Assistant | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2007-08-06 |
| 1104975168 | Clinton Clark Dpm LLC | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2007-01-09 |
| 1578514618 | Scott A Graviet | Podiatrist | 6051 N Eagle Rd, Boise, ID 83713-0997 | 2006-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 213EP1101X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Primary Podiatric Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497223879 | James Dawn | Podiatrist | 1775 W State St # 299, Boise, ID 83702-3924 | 2018-11-05 |
| 1962783233 | Boise Foot and Ankle Group | Podiatrist | 727 E Riverpark Ln, Suite 100, Boise, ID 83706-4069 | 2011-08-31 |
| 1801071550 | Randy E Lowe | Podiatrist | 230 W Mallard Dr, Suite C, Boise, ID 83706-6600 | 2007-12-31 |
| 1548276165 | Dr. William Stano | Podiatrist | 220 W Jefferson St, Boise, ID 83702-6044 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548564412 | Dpmgilbertnrid LLC | Podiatrist | 3690 Ridgewood Rd, Pocatello, ID 83201-7704 | 2011-01-06 |
| 1093924813 | Craig D Holman | Podiatrist | 496 Shoup Ave W Ste B, Twin Falls, ID 83301-5043 | 2007-05-21 |
| 1033105275 | Ronald W Alm | Podiatrist | 803 16th Ave, Lewiston, ID 83501-3733 | 2005-09-22 |
| 1598197857 | Christensen Foot & Ankle Clinic | Podiatrist | 1777 E Clark St, Suite 220, Pocatello, ID 83201-3357 | 2013-08-08 |
| 1063769297 | Snake River Podiatry Pllc | Podiatrist | 3690 Ridgewood Rd, Pocatello, ID 83201-7704 | 2012-08-07 |
| 1588993018 | Dpmcallnrid LLC | Podiatrist | 718 Beulahs Ln, Idaho Falls, ID 83401-2340 | 2009-12-11 |
| 1891920476 | Don J Gilbert | Podiatrist | 1555 E Clark St, Pocatello, ID 83201-4133 | 2009-05-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.