Healthcare Provider Details

I. General information

NPI: 1184563793
Provider Name (Legal Business Name): BART WHITING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 343 N
RIGBY ID
83442
US

IV. Provider business mailing address

3722 343 N
RIGBY ID
83442
US

V. Phone/Fax

Practice location:
  • Phone: 208-589-0037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: