Saint Alphonsus Nephrology Center
Clinic/Center, End-Stage Renal Disease (ESRD) Treatment in Ontario, OR. Organization (NPI-2).
NPI number1073504635
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1073504635
- Entity type
- Organization (NPI-2)
- Legal business name
- Saint Alphonsus Nephrology Center
- Organization subpart
- No
- Enumeration date
- Nov 2, 2005
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QE0700X | Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | 170009 | OR | Yes |
Practice location
515 East LnOntario, OR 97914-3953
Phone 541-889-9557 · Fax 541-881-8721
Mailing address
5610 Gage StSte B
Boise, ID 83706-1349
Phone 208-367-3076 · Fax 208-367-6909
Authorized official
Jan M Jacobs
Accounts Receivable Manager
2083673076
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