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BOISE SKIN CLINIC PLLC
NPI 1104220797
Dermatology in Boise, ID

Active since October 10, 2014CLIA 13D2091363 · Microscopy
1636 S HADLEY AVE, BOISE, ID 83709(208) 209-7898(208) 258-2079 Get Directions Write a Review

NPPES record last updated: January 22, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Boise Skin Clinic Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BOISE SKIN CLINIC PLLC (NPI 1104220797) is a healthcare organization registered as a dermatology in Boise, Idaho and active in the NPI registry since October 2014. The organization holds a CLIA Microscopy certificate valid through July 12, 2027 and lists Marnie R Ririe, Manager, as its authorized official.

NPPES Registry Identity

NPI1104220797
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameBOISE SKIN CLINIC PLLC
Location Address1636 S HADLEY AVEBoise, ID 83709-2684
Mailing Address1636 S Hadley AveBoise, ID 83709-2684 · (208) 209-7898 · Fax (208) 258-2079
Phone(208) 209-7898
Fax(208) 258-2079
Organization SubpartNo
Authorized OfficialMarnie R RirieManager · (208) 258-2078
Enumeration DateOctober 10, 2014
Last NPPES UpdateJanuary 22, 2019
✔ NPI 1104220797 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in ID · M-9342
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
1636 S HADLEY AVE, Boise, ID 83709
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Other Identifiers 1

Medicaid1134170855ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 13D2091363

Boise Skin Clinic, PLLC · Boise, ID
Active · expires Jul 12, 2027
CLIA Number13D2091363
Laboratory TypePhysician Office
Certificate Effective DateJuly 13, 2025
Certificate Expiration DateJuly 12, 2027
Laboratory DirectorMarnie Ririe
Laboratory Phone(208) 258-2078
Laboratory LocationBoise Skin Clinic, PLLC1636 Hadley Ave, Boise, ID 83709
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Boise Skin Clinic PLLC's NPI number?

The NPI number for Boise Skin Clinic PLLC is 1104220797. It was assigned to this organization in the NPPES registry on October 10, 2014.

Where is Boise Skin Clinic PLLC located?

Boise Skin Clinic PLLC is located at 1636 S Hadley Ave, Boise, ID 83709. The listed phone number is (208) 209-7898.

What is Boise Skin Clinic PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Boise Skin Clinic PLLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 13D2091363) is associated with this NPI, valid through July 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Boise Skin Clinic PLLC accept?

Health plans from Moda Health Plan, Inc. list Boise Skin Clinic PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Boise Skin Clinic PLLC was last updated on January 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.