# IDAHODHWBH3 MIDLEVEL GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1972631265
- **Authorized official:** MR. TODD L HURT M.S. (FIELD OPERATIONS MANAGER)
- **Authorized official phone:** (208) 455-7057

## Contact information

- **Practice address:** 3402 FRANKLIN RD, CALDWELL, ID 83605-6932
- **Practice address phone:** (208) 459-0092
- **Practice address fax:** (208) 454-7714
- **Mailing address:** 3402 FRANKLIN RD, CALDWELL, ID 83605-6932
- **Mailing address phone:** (208) 459-0092
- **Mailing address fax:** (208) 454-7714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010018824 | BLUESHIELD | — |
| 05 | — | 8073346 | — | ID |
| 01 | — | HW348 | BLUE CROSS OF IDAHO | — |