=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043031206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERGENCY RESPONDERS HEALTH CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ROCK POINTE III; SUITE 1080 1330 N. WASHINGTON STREET
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-229-3742
-----------------------------------------------------
Fax | 208-229-8450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 44828
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83711-0828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-229-3742
-----------------------------------------------------
Fax | 208-229-8450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT JOSEPH HILVERS JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 208-229-3742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------