| Organization Name: | BOISE MINOR EMERGENCY CENTER PA |
| NPI Number: | 1114938909 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY CANOVA (OWNER) |
| Mailing Address: | 2993 N Cole Rd Boise |
| State: | ID US |
| Postal Code: | 837045977 |
| Phone Number: | 2083780400 |
| Fax Number: | 2083787529 |
| NPI Enumeration Date: | 08/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |