MEDICARE: SCOTT R HIATT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	O289	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010149338	OTHER	ID	BLUE SHIELD
2	S5486	OTHER	ID	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093705030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT R HIATT D.O.

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:	208-463-5050
Fax Number	:	208-463-5040

Provider Business Practice Location Address
First Line	:	1524 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6008
Country	:	US
Telephone Number	:	208-463-5050
Fax Number	:	208-463-5040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	05/21/2014

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Directions to “ SCOTT R HIATT D.O.” Practice Location

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