Provider Demographics
NPI:1427298025
Name:BOISVERT, INC.
Entity type:Organization
Organization Name:BOISVERT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:208-371-3400
Mailing Address - Street 1:423 W WYCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8385
Mailing Address - Country:US
Mailing Address - Phone:208-371-3400
Mailing Address - Fax:208-467-1737
Practice Address - Street 1:300 1ST AVE N
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3498
Practice Address - Country:US
Practice Address - Phone:208-371-3400
Practice Address - Fax:208-465-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDQA110135F344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808206800Medicaid