Healthcare Provider Details

I. General information

NPI: 1861300543
Provider Name (Legal Business Name): WILLIAM A FORSYTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 E WOODSTONE DR
HAYDEN ID
83835-8114
US

IV. Provider business mailing address

2455 E WOODSTONE DR
HAYDEN ID
83835-8114
US

V. Phone/Fax

Practice location:
  • Phone: 208-271-5947
  • Fax: 208-382-8457
Mailing address:
  • Phone: 208-271-5947
  • Fax: 208-382-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM FORSYTH
Title or Position: OWNER
Credential: MD
Phone: 208-271-5947