MEDICARE: IDAHO HEART CARE

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1477747632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDAHO HEART CARE

Provider Business Mailing Address
First Line	:	1055 N CURTIS RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-1309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 W CHERRY LN
Second Line	:	SUITE 205
City	:	MERIDIAN
State	:	ID
Zip	:	83642-8531
Country	:	US
Telephone Number	:	208-367-8484
Fax Number	:	208-367-8456

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. DOUGLAS HILL
Credential	:	M.D.
Telephone Number	:	208-367-7553

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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Directions to “IDAHO HEART CARE ” Practice Location

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