Provider Demographics
NPI:1174916969
Name:RENEE O. BILD, PLLC
Entity type:Organization
Organization Name:RENEE O. BILD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-336-3031
Mailing Address - Street 1:1718 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3949
Mailing Address - Country:US
Mailing Address - Phone:208-336-3031
Mailing Address - Fax:208-336-3228
Practice Address - Street 1:1718 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3949
Practice Address - Country:US
Practice Address - Phone:208-336-3031
Practice Address - Fax:208-336-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1338261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)