Provider Demographics
NPI:1457077307
Name:AERIS PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:AERIS PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-421-0033
Mailing Address - Street 1:706 N COLLEGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5824
Mailing Address - Country:US
Mailing Address - Phone:208-391-5952
Mailing Address - Fax:877-409-2920
Practice Address - Street 1:706 N COLLEGE RD STE C
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5824
Practice Address - Country:US
Practice Address - Phone:208-391-5952
Practice Address - Fax:877-409-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty