OrganizationActive
Innovative Health Care Concepts Inc
NPI 1861035248 · Primary Care Nurse Practitioner · Idaho Falls, ID
Provider details
- NPI number
- 1861035248
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Lisa Smith, Program Director(208) 523-1130
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Family Nurse Practitioner363LF0000X
Physician Assistants & Advanced Practice Nursing Providers
Practice location
115 E 16th St
Idaho Falls, ID 83404-5919
Phone: (208) 523-6727
Fax: (208) 523-6729
Approximate (ZIP-level) locationGet directions
Mailing address
111 E 16th St
Idaho Falls, ID 83404-5919
Registry dates
- Enumerated
- 2019-10-18
- Last updated
- 2020-06-02
- Certified
- 2020-06-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.