Provider Demographics
NPI:1013712330
Name:IDAHO CONCIERGE MEDICINE LLC
Entity type:Organization
Organization Name:IDAHO CONCIERGE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJO
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C
Authorized Official - Phone:208-314-1325
Mailing Address - Street 1:11696 W GABRIELLE CT # 83713
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-7812
Mailing Address - Country:US
Mailing Address - Phone:208-314-1325
Mailing Address - Fax:
Practice Address - Street 1:11696 W GABRIELLE CT # 83713
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7812
Practice Address - Country:US
Practice Address - Phone:208-314-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty