Provider Demographics
NPI:1962783233
Name:BOISE FOOT AND ANKLE GROUP
Entity type:Organization
Organization Name:BOISE FOOT AND ANKLE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACKMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-319-0497
Mailing Address - Street 1:PO BOX 16820
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83715-6820
Mailing Address - Country:US
Mailing Address - Phone:208-323-9130
Mailing Address - Fax:208-323-9070
Practice Address - Street 1:727 E RIVERPARK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-4069
Practice Address - Country:US
Practice Address - Phone:208-319-0497
Practice Address - Fax:208-323-9070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKMER FOOT AND ANKLE GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty