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Organization

HNI MEDICAL SERVICES OF IDAHO, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RYAN CARLETTI (VP OF OPERATIONS)
(330) 727-3530
Entity
Organization

Contact information

Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(512) 730-3056
(888) 730-1925
Mailing address
7500 RIALTO BLVD STE 1-140, AUSTIN, TX 78735-8534
(512) 730-3056
(888) 730-1925

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
208M00000X
Hospitalist Physician
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1063928638
ID
Enumeration date
12/19/2017
Last updated
08/24/2023
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