Provider Demographics
NPI:1508552043
Name:HIGH DESERT HEART & VASCULAR
Entity Type:Organization
Organization Name:HIGH DESERT HEART & VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & FOUNDING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KEVIN PATRICK
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-834-1046
Mailing Address - Street 1:8854 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4844
Mailing Address - Country:US
Mailing Address - Phone:208-834-1046
Mailing Address - Fax:
Practice Address - Street 1:8854 W EMERALD ST STE 260
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4860
Practice Address - Country:US
Practice Address - Phone:986-888-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699720383OtherDANA PEACHEY
1942474853OtherDANIEL NOONAN, MD NPI
1710914528OtherDAVID HINCHMAN, MD, NPI
1285851337OtherFRED COSTELLO, MD NPI
1679733414OtherJOSHUA MOZES, MD, NPI