Healthcare Provider Details

I. General information

NPI: 1508552043
Provider Name (Legal Business Name): HIGH DESERT HEART & VASCULAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E GOLDSTONE DR STE 230
MERIDIAN ID
83642-1224
US

IV. Provider business mailing address

3015 E GOLDSTONE DR STE 230
MERIDIAN ID
83642-1224
US

V. Phone/Fax

Practice location:
  • Phone: 208-834-1046
  • Fax:
Mailing address:
  • Phone: 208-834-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN PRICE
Title or Position: CEO
Credential:
Phone: 208-781-6039