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NPI Code Detail

MEDICARE: KASSADY ELLEN MARIE HINMAN DO, BS

MEDICARE: KASSADY ELLEN MARIE HINMAN DO, BS
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
1207R00000XInternal Medicine Physician1275471468ID
2390200000XStudent in an Organized Health Care Education/Training ProgramKY

General Provider Information

NPI Number : 1275471468
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSADY ELLEN MARIE HINMAN DO, BS
Provider Business Mailing Address
First Line : 500 W FORT ST # 111R
Second Line :
City : BOISE
State : ID
Zip : 83702-4599
Country : US
Telephone Number : 208-422-1000
Fax Number :
Provider Business Practice Location Address
First Line : 500 W FORT ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4599
Country : US
Telephone Number : 208-422-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 06/09/2026

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