Healthcare Provider Details

I. General information

NPI: 1457545691
Provider Name (Legal Business Name): IDAHO HEART CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 CURTISIAN AVE SUITE 200
BOISE ID
83704-8880
US

IV. Provider business mailing address

1055 N CURTIS RD
BOISE ID
83706-1309
US

V. Phone/Fax

Practice location:
  • Phone: 208-322-1680
  • Fax: 208-322-1695
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS HILL
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 208-367-7553