SPARKMD NPI 1427443613

NPI Information

SPARKMD is a primary care clinic center in Boise, ID. SPARKMD NPI is 1427443613. The provider is registered as an organization entity type.
The provider Is Doing Business As Sparkmd.

The provider's business location address is:

302 W IDAHO ST
BOISE, ID
ZIP 83702-039
Phone: (208) 369-4590

The provider's authorized official is Julie Kristen Gunther .
The authorized official title is Owner, Physician and has the following contact phone number (208) 369-4590.

The CLIA number assigned to this NPI record is 13D2084783 - independent with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/3/2015 and was last updated on 4/21/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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