Mountain States Oncology Group

NPI #1386750859 in Boise, Idaho

Provider Information

NPI Number: 1386750859
Entity Type: Organization
Organization Name: Mountain States Oncology Group
Primary Specialty: Specialist
Enumeration Date: Aug 21, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 100 E IDAHO ST
City: Boise
State: Idaho
ZIP Code: 83712-6223
Phone: (208) 343-3223

Authorized Official

Name: JONI SULLIVAN
Title: BUSINESS ADMINSTRATOR
Phone: (208) 343-3223

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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