| Alpine Behavioral Health | |
|
8590 W Fairview Ave Ste A Boise ID 83704-8320 | |
| (208) 672-0260 | |
| (208) 321-7750 |
| Full Name | Alpine Behavioral Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 8590 W Fairview Ave Ste A, Boise, Idaho |
| Authorized Official Name and Position | Bradley Midgett (OWNER) |
| Authorized Official Contact | 2086720260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alpine Behavioral Health 8590 W Fairview Ave Ste A Boise ID 83704-8320 Ph: (208) 672-0260 | Alpine Behavioral Health 8590 W Fairview Ave Ste A Boise ID 83704-8320 Ph: (208) 672-0260 |
| NPI Number | 1437208899 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 01/20/2022 |
| Certification Date | 01/20/2022 |
| Medicare PECOS PAC ID | 7810123999 |
|---|---|
| Medicare Enrollment ID | O20131119001737 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437208899 | NPI | - | NPPES |
| 807585600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| 305S00000X | Point Of Service | LCSW-24969 (Idaho) | Secondary |
| Provider Name | Bradley Midgett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831462001 PECOS PAC ID: 7315230679 Enrollment ID: I20160725000304 |
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