NPI age
19 years
Enumerated 2006-09-26
Across 99 active clinic/center providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 03384 | BLUE CROSS ASC# |
| 01 (ID) | 000010006663 | REGENCE ASC # |
| 05 (ID) | 804229000 |
Single-site organization. Only one practice location on file.
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