Organization
IDAHODHWBH3 MIDLEVEL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD L HURT M.S. (FIELD OPERATIONS MANAGER)
(208) 455-7057
Entity
Organization
Contact information
Practice address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 459-0092
(208) 454-7714
Mailing address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 459-0092
(208) 454-7714
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010018824
BLUESHIELD
—
05
—
8073346
—
ID
01
—
HW348
BLUE CROSS OF IDAHO
—
Enumeration date
03/01/2007
Last updated
08/22/2020
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