Provider Demographics
NPI:1770180754
Name:HILL, JAMES BURTON
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BURTON
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 S CARBINE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-1243
Mailing Address - Country:US
Mailing Address - Phone:865-333-1014
Mailing Address - Fax:
Practice Address - Street 1:2205 CHANNING WAY STE A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8016
Practice Address - Country:US
Practice Address - Phone:208-529-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9039291-3102163W00000X
NDR54844367500000X
IDCS66320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse