Provider Demographics
NPI:1306883244
Name:BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC
Entity type:Organization
Organization Name:BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-3410
Mailing Address - Street 1:PO BOX 2160
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0908
Mailing Address - Country:US
Mailing Address - Phone:208-263-3410
Mailing Address - Fax:
Practice Address - Street 1:6615 COMANCHE ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805
Practice Address - Country:US
Practice Address - Phone:208-267-1718
Practice Address - Fax:208-267-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0176255OtherWA LABOR AND INDUSTRY
ID8H104OtherBLUE CROSS OF IDAHO GROUP
DB1056OtherRAILROAD MEDICARE
ID000010142695OtherREGENCE OF IDAHO GROUP
WA8905326OtherWA L AND I CRIME VICTIMS
131822OtherMEDICARE FQHC
ID806590100Medicaid
ID807823200OtherHEALTHY CONNECTIONS
ID806591800OtherHEALTHY CONNECTIONS
DB1056OtherRAILROAD MEDICARE
ID807823200OtherHEALTHY CONNECTIONS