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General NPI Number Information
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NPI Number | 1023702099
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Entity Type | Organization
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Legal Business Name | HART & CO IDAHO LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1015 W HAYS ST STE 105
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City | BOISE
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State | ID
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Zip | 83702-5412
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Country | US
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Telephone | 208-476-1995
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Fax | 208-227-8612
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Provider Business Mailing Address
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Address Line | 1015 W HAYS ST STE 105
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City | BOISE
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State | ID
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Zip | 83702-5412
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Country | US
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Telephone | 208-476-1995
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Fax | 208-227-8612
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Authorized Official
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Title or Position | OWNER
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Name | JILL K HART
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Credential | FNP-C
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Telephone | 208-476-1995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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