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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
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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