Healthcare Provider Details

I. General information

NPI: 1447202726
Provider Name (Legal Business Name): CARDIOVASCULAR & CHEST SURGICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N. 1ST ST. #280
BOISE ID
83702
US

IV. Provider business mailing address

333 N. 1ST ST. #280
BOISE ID
83702
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-6545
  • Fax: 208-345-1213
Mailing address:
  • Phone: 208-345-6545
  • Fax: 208-345-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DONETTA HESGARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-345-6545