| Boise Family Medicine Center | |
|
10798 W. Overland Rd Boise ID 83709-1329 | |
| (208) 377-3368 | |
| (208) 322-4691 |
| Full Name | Boise Family Medicine Center |
|---|---|
| Speciality | Family Medicine |
| Location | 10798 W. Overland Rd, Boise, Idaho |
| Authorized Official Name and Position | Dale L Mock (OWNER/PHYSICIAN) |
| Authorized Official Contact | 2083773368 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boise Family Medicine Center 10798 W. Overland Rd Boise ID 83709-1329 Ph: (208) 377-3368 | Boise Family Medicine Center 10798 W. Overland Rd Boise ID 83709-1329 Ph: (208) 377-3368 |
| NPI Number | 1376747790 |
|---|---|
| Provider Enumeration Date | 06/11/2007 |
| Last Update Date | 09/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376747790 | NPI | - | NPPES |
| 002643200 | Medicaid | ID | |
| 32110 | Other | ID | BLUE CROSS |
| 000010006306 | Other | ID | BLUE SHIELD |
| 000010006306 | Other | ID | BLUE SHIELD GROUP NUMBER |
| 32110 | Other | ID | BLUE CROSS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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