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BEACON PAIN CLINIC

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Company Details

Name: BEACON PAIN CLINIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 09 Dec 2013 (12 years ago)
Entity Number: 507754
Place of Formation: IDAHO
File Number: 0000507754
ZIP code: 83702
County: Ada County
Mailing Address: 115 W MAIN ST #102 BOISE, ID 83702

National Provider Identifier

NPI Number:
1477941672

Authorized Person:

Name:
DR. REBEKAH GUY
Role:
PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
208VP0014X - Interventional Pain Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
2083424710

Filing

Filing Name Filing Number Filing date
Initial Filing 0000507754 2013-12-09

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State