Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Boise State University

Organization Family Medicine Physician · NPI 1134905243

Boise State University is a Family Medicine Physician in Boise, Idaho. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
4
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Practice location Address checks out

2100 University Dr Ste 107
Boise, ID 83725-0001
Phone: (208) 426-1523
Fax: (208) 426-2302
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community Health Clinic/Center (primary) Taxonomy 261QC1500X
Family Medicine Physician Taxonomy 207Q00000X
Public Health & General Preventive Medicine Physician Taxonomy 2083P0901X
Public Health or Welfare Agency Taxonomy 251K00000X

Record details

NPI number1134905243
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Stephanie Hudon — Clinical Program Director · (208) 995-3765
Other names Boise State University Public Health Clinic; Boise State University Public Health Clinic
NPI enumeratedSeptember 5, 2023
Last updated in NPPESAugust 29, 2024
Certification dateAugust 29, 2024
Mailing address1910 University Dr, Ms 1855, Boise, ID 83725

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