NPIMap

Organization Active NPI

Idahodhwbh3 Midlevel Group

  • Nurse Practitioner
  • Caldwell, ID
National Provider Identifier
1972631265
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
IDAHODHWBH3 MIDLEVEL GROUP
Practice address
3402 Franklin Rd
Caldwell, ID 83605-6932
Phone
(208) 459-0092
Fax
(208) 454-7714
NPI assigned
Mar 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Todd L Hurt, M.S.
Title
Field Operations Manager
Phone
(208) 455-7057

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

3402 Franklin Rd
Caldwell, ID 83605-6932

Mailing address

3402 Franklin Rd
Caldwell, ID 83605-6932
Phone (208) 459-0092

Other identifiers 3

IdentifierTypeStateIssuer
000010018824OtherBLUESHIELD
HW348OtherBLUE CROSS OF IDAHO
8073346MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dept of Health Welfare Reg II Amh Grangeville114 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972631265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3402 FRANKLIN RD",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836056932",
            "telephone_number": "208-459-0092",
            "fax_number": "208-454-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3402 FRANKLIN RD",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836056932",
            "telephone_number": "208-459-0092",
            "fax_number": "208-454-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHODHWBH3 MIDLEVEL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HURT",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "FIELD OPERATIONS MANAGER",
        "authorized_official_telephone_number": "208-455-7057",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "000010018824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "HW348",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073346",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.