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General NPI Number Information
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NPI Number | 1053521344
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Entity Type | Organization
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Legal Business Name | HEALTHCARE WITH HEART LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 823 CENTER AVE
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-3396
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Fax | 208-642-9060
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Provider Business Mailing Address
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Address Line | 823 CENTER AVE
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-3396
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Fax | 208-642-9060
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD EUGENE CARROLL
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Credential | M.D.
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Telephone | 208-989-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M4116
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | N19189
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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