NPIMap

Organization Active NPI

Heartland Pharmacy - Idaho Falls

  • Durable Medical Equipment & Medical Supplies
  • Ammon, ID
National Provider Identifier
1548423338
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1624LS Issued in ID
Legal business name
HEARTLAND PHARMACY - IDAHO FALLS
Practice address
3250 E 17TH St
Ammon, ID 83406-6758
Phone
(208) 552-7677
Fax
(208) 552-2103
NPI assigned
Jul 2, 2008
Last updated
Nov 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Reece Christensen
Title
Ceo President
Phone
(208) 497-3575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1624LS ID Primary

Addresses

Primary practice location

3250 E 17TH St
Ammon, ID 83406-6758

Mailing address

1790 Sabin Dr
Ammon, ID 83406-6747
Phone (208) 497-3575

Other identifiers 4

IdentifierTypeStateIssuer
0562258MedicaidMT
2038144MedicaidWA
806141400MedicaidID
1548423338MedicaidUT

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1548423338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 SABIN DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066747",
            "telephone_number": "208-497-3575",
            "fax_number": "208-552-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 E 17TH ST",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066758",
            "telephone_number": "208-552-7677",
            "fax_number": "208-552-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND PHARMACY - IDAHO FALLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "REECE",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "208-497-3575"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "1624LS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0562258",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2038144",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806141400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548423338",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ammon, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.