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General NPI Number Information
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NPI Number | 1184496051
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Entity Type | Organization
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Legal Business Name | IDAHO HEART PHYSICIAN GROUP PLLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 2985 CORTEZ AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7554
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Country | US
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Telephone | 208-523-3373
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Fax | 208-523-8746
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Provider Business Mailing Address
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Address Line | 955 PIER VIEW DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4918
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Country | US
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Telephone | 208-557-5218
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Fax | 208-529-9732
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN CHAMBERS
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Credential | MD
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Telephone | 208-403-1127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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