| Humphreys Diabetes Center | |
|
1226 W River St Boise ID 83702-7049 | |
| (208) 331-1155 | |
| (208) 383-0190 |
| Full Name | Humphreys Diabetes Center |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 1226 W River St, Boise, Idaho |
| Authorized Official Name and Position | Robert W Scanlon (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2083311155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Humphreys Diabetes Center 1226 W River St Boise ID 83702-7049 Ph: (208) 331-1155 | Humphreys Diabetes Center 1226 W River St Boise ID 83702-7049 Ph: (208) 331-1155 |
| NPI Number | 1821263088 |
|---|---|
| Provider Enumeration Date | 04/28/2008 |
| Last Update Date | 11/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821263088 | NPI | - | NPPES |
| 8G502 | Other | ID | BLUE CROSS |
| 806348400 | Medicaid | ID | |
| 1374744 | Other | ID | MEDICARE MNT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY331 (Idaho) | Secondary |
| 133V00000X | Dietitian, Registered | D33630 (Idaho) | Primary |
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