Healthcare Provider Details

I. General information

NPI: 1609335090
Provider Name (Legal Business Name): HURST MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 OVERLAND AVE STE 1
BURLEY ID
83318
US

IV. Provider business mailing address

1700 OVERLAND AVE STE 1
BURLEY ID
83318
US

V. Phone/Fax

Practice location:
  • Phone: 208-825-6193
  • Fax: 208-825-6199
Mailing address:
  • Phone: 208-825-6193
  • Fax: 208-825-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY HURST
Title or Position: NP, OWNER
Credential: NP
Phone: 208-825-6193