| Richard Radnovich Do Pc | |
|
4850 N Rosepoint Way Suite 100 Boise ID 83713-5262 | |
| (208) 939-2100 | |
| (208) 939-4411 |
| Full Name | Richard Radnovich Do Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 4850 N Rosepoint Way, Boise, Idaho |
| Authorized Official Name and Position | Richard G Radnovich (OWNER) |
| Authorized Official Contact | 2089392100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Radnovich Do Pc 4850 N Rosepoint Way Suite 100 Boise ID 83713-5262 Ph: (208) 939-2100 | Richard Radnovich Do Pc 4850 N Rosepoint Way Suite 100 Boise ID 83713-5262 Ph: (208) 939-2100 |
| NPI Number | 1417143926 |
|---|---|
| Provider Enumeration Date | 09/18/2007 |
| Last Update Date | 09/18/2007 |
| Medicare PECOS PAC ID | 9739132218 |
|---|---|
| Medicare Enrollment ID | O20050224000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417143926 | NPI | - | NPPES |
| 000010139957 | Other | ID | REGENCE BLUE SHIELD OF ID |
| S3978 | Other | ID | BLUE CROSS OF IDAHO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard G Radnovich |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1407944655 PECOS PAC ID: 9537063672 Enrollment ID: I20040805001416 |
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