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NPI Code Detail

MEDICARE: HIGH DESERT WOUND CARE AND HYPERBARICS PLLC

MEDICARE: HIGH DESERT WOUND CARE AND HYPERBARICS PLLC
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
1261QI0500XInfusion Therapy Clinic/Center
2207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) Physician

General Provider Information

NPI Number : 1700621661
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIGH DESERT WOUND CARE AND HYPERBARICS PLLC
Provider Business Mailing Address
First Line : PO BOX 45060
Second Line :
City : BOISE
State : ID
Zip : 83711-5060
Country : US
Telephone Number : 208-649-8347
Fax Number :
Provider Business Practice Location Address
First Line : 1906 FAIRVIEW AVE STE 130
Second Line :
City : CALDWELL
State : ID
Zip : 83605-5433
Country : US
Telephone Number : 208-649-8347
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : AMI YANTIS
Credential :
Telephone Number : 208-649-8347
Provider Enumeration Date : 07/01/2024
Last Update Date : 07/10/2024

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