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General NPI Number Information
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NPI Number | 1508552043
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Entity Type | Organization
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Legal Business Name | HIGH DESERT HEART & VASCULAR
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3015 E GOLDSTONE DR STE 230
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City | MERIDIAN
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State | ID
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Zip | 83642-1224
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Country | US
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Telephone | 208-834-1046
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 E GOLDSTONE DR STE 230
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City | MERIDIAN
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State | ID
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Zip | 83642-1224
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Country | US
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Telephone | 208-834-1046
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARREN PRICE
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Credential |
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Telephone | 208-781-6039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC3500X
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Taxonomy Name | Cardiac Rehabilitation Registered Nurse
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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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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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