Healthcare Provider Details

I. General information

NPI: 1457077307
Provider Name (Legal Business Name): AERIS PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N COLLEGE RD STE C
TWIN FALLS ID
83301-5824
US

IV. Provider business mailing address

706 N COLLEGE RD STE C
TWIN FALLS ID
83301-5824
US

V. Phone/Fax

Practice location:
  • Phone: 208-391-5952
  • Fax: 877-409-2920
Mailing address:
  • Phone: 208-391-5952
  • Fax: 877-409-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JARED HANSEN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 208-421-0033