# INNOVATIVE HEALTH CARE CONCEPTS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861035248
- **Authorized official:** MRS. LISA MICHELLE SMITH (PROGRAM DIRECTOR)
- **Authorized official phone:** (208) 523-1130

## Contact information

- **Practice address:** 115 E 16TH ST, IDAHO FALLS, ID 83404-5919
- **Practice address phone:** (208) 523-6727
- **Practice address fax:** (208) 523-6729
- **Mailing address:** 111 E 16TH ST, IDAHO FALLS, ID 83404-5919
- **Mailing address phone:** (208) 523-1130
- **Mailing address fax:** (208) 529-6501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/18/2019
- **Last updated:** 06/02/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2741600 | — | ID |