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Organization
INNOVATIVE HEALTH CARE CONCEPTS INC
Active
Organization
INNOVATIVE HEALTH CARE CONCEPTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA MICHELLE SMITH (PROGRAM DIRECTOR)
(208) 523-1130
Entity
Organization
Contact information
Practice address
115 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-6727
(208) 523-6729
Mailing address
111 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-1130
(208) 529-6501
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2741600
—
ID
Enumeration date
10/18/2019
Last updated
06/02/2020
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