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General NPI Number Information
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NPI Number | 1457077307
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Entity Type | Organization
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Legal Business Name | AERIS PEDIATRICS, PLLC
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 706 N COLLEGE RD STE C
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City | TWIN FALLS
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State | ID
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Zip | 83301-5824
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Country | US
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Telephone | 208-391-5952
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Fax | 877-409-2920
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Provider Business Mailing Address
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Address Line | 706 N COLLEGE RD STE C
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City | TWIN FALLS
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State | ID
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Zip | 83301-5824
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Country | US
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Telephone | 208-391-5952
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Fax | 877-409-2920
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. JARED HANSEN
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Credential | MD
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Telephone | 208-421-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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