BOISE STATE UNIVERSITY
NPI: 1134905243
· BOISE, ID 83725
· Family Medicine Physician
· NPI assigned 09/05/2023
$423.00
Total Medicaid Paid
Provider Details
| Authorized Official | HUDON, STEPHANIE (CLINICAL PROGRAM DIRECTOR) |
| NPI Enumeration Date | 09/05/2023 |
Related Entities
Other providers sharing the same authorized official: HUDON, STEPHANIE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
25 |
$423.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
25 |
$423.00 |