MEDICARE: AAA AMERICAN HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	111N00000X	Chiropractor
3	171M00000X	Case Manager/Care Coordinator
4	225100000X	Physical Therapist
5	251S00000X	Community/Behavioral Health Agency
6	261QP3300X	Pain Clinic/Center
7	363A00000X	Physician Assistant
8	207Q00000X	Family Medicine Physician
9	207R00000X	Internal Medicine Physician
10	208D00000X	General Practice Physician
11	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
12	363LP2300X	Primary Care Nurse Practitioner
13	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1285979757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAA AMERICAN HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	665 JOHN ADAMS PKWY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-4072
Country	:	US
Telephone Number	:	208-419-0144
Fax Number	:	208-789-2705

Provider Business Practice Location Address
First Line	:	1301 E 17TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6273
Country	:	US
Telephone Number	:	208-538-3122
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN HATCH
Credential	:
Telephone Number	:	208-538-3122

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	10/26/2020

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Directions to “AAA AMERICAN HEALTHCARE LLC ” Practice Location

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