Provider Demographics
NPI:1417151804
Name:JEFFREY F HARTFORD MD
Entity Type:Organization
Organization Name:JEFFREY F HARTFORD MD
Other - Org Name:NORTHVIEW MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:208-376-8337
Mailing Address - Street 1:8324 W NORTHVIEW STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-376-8337
Mailing Address - Fax:208-376-8344
Practice Address - Street 1:8324 W NORTHVIEW STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-376-8337
Practice Address - Fax:208-376-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-03-13
Deactivation Date:2008-07-10
Deactivation Code:
Reactivation Date:2008-10-23
Provider Licenses
StateLicense IDTaxonomies
IDM5269174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003747400Medicaid
ID1376219Medicare ID - Type Unspecified
ID1120685Medicare Oscar/Certification
ID003747400Medicaid