BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC (NPI# 1306883244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306883244 |
| Entity Type | Organization |
| Organization Name | BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC |
| Other Organization Name | KANIKSU HEALTH SERVICES |
| Practice Address |
6615 Comanche St Bonners Ferry ID 83805 |
| Mailing Address |
30410 Highway 200 Ponderay ID 83852-9601 |
| Practice Telephone | 2082671718 |
| Practice Fax Number | 2082677739 |
| Mailing Telephone | 2082633410 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2012-07-09 |
| Authorized Official Name | VICKI KING (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2082633410 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE FQHC | 131822 | 01 | |
| WA | WA LABOR AND INDUSTRY | 0176255 | 01 |
| WA | WA L AND I CRIME VICTIMS | 8905326 | 01 |
| ID | 806590100 | 05 | |
| ID | BLUE CROSS OF IDAHO GROUP | 8H104 | 01 |
| ID | HEALTHY CONNECTIONS | 806591800 | 01 |
| RAILROAD MEDICARE | DB1056 | 01 | |
| ID | HEALTHY CONNECTIONS | 807823200 | 01 |
| ID | REGENCE OF IDAHO GROUP | 000010142695 | 01 |
| Other Name | Type Code |
|---|---|
| Kaniksu Health Services | Doing Business As Name - Organization |
| Street Address |
6615 COMANCHE ST |
| City | BONNERS FERRY |
| State | ID |
| Zip Code | 83805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679702088 | Hailey J Rose | Pediatrics | 6615 Comanche St, Kaniksu Health Services, Bonners Ferry, ID 83805 | 2009-07-07 |
| 1316024748 | Mona Kim-brown | Counselor | 6615 Comanche St, Bonners Ferry, ID 83805 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366990996 | Nicole Diana Madill | Counselor | 687 Cody Street, Bonners Ferry, ID 83805 | 2016-09-12 |
| 1154770295 | Rachel Meiland Webster | Social Worker | 6686 Augusta Bldg 100, Bonners Ferry, ID 83805 | 2016-06-09 |
| 1205211786 | Robert Rossi | Social Worker | Kaniksu Health Services, 6615 Comanche St, Bonners Ferry, ID 83805 | 2015-07-24 |
| 1154660041 | Mark R. Barker, O.d.p.c. | Optometrist | 7177 Main St., Bonners Ferry, ID 83805 | 2013-02-12 |
| 1003182668 | Jessica Faye Horricks | Dentist | 6615 Commanche, Bonners Ferry, ID 83805 | 2012-03-28 |
| 1427334929 | Tanya Marie Allmaras | Physician Assistant | 6635 Comanche Street, Bonners Ferry, ID 83805 | 2011-10-27 |
| 1114259769 | Joshua Olen Shelton | Chiropractor | 6389 Bonner St., Bonners Ferry, ID 83805 | 2010-02-08 |
| 1558690644 | April C Christman | Social Worker | 6615 Comanche Street, Bonners Ferry, ID 83805 | 2009-12-18 |
| 1407006067 | Denys Taipale-knight | Counselor | 385 Moose Ridge Lane, Bonners Ferry, ID 83805 | 2008-09-19 |
| 1013126457 | John Pierce Brownlee Jr. | Registered Nurse | 6640 Kaniksu Street, Boundary Community Hospital, Bonners Ferry, ID 83805 | 2007-05-22 |
| Find all providers in zip 83805 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770649154 | Boundary Regional Community Health Center, Inc. | Clinic/Center | 6635 Comanche St, Bonners Ferry, ID 83805-7523 | 2006-12-29 |
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| Find all providers with the same taxonomy | ||||
| City | BONNERS FERRY |
| Zip Code | 83805 |
Please comment or provide details below to improve the information on BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.