Provider Demographics
NPI:1053521344
Name:HEALTHCARE WITH HEART LLC
Entity type:Organization
Organization Name:HEALTHCARE WITH HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-989-0070
Mailing Address - Street 1:823 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2535
Mailing Address - Country:US
Mailing Address - Phone:208-642-3396
Mailing Address - Fax:208-642-9060
Practice Address - Street 1:823 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2535
Practice Address - Country:US
Practice Address - Phone:208-642-3396
Practice Address - Fax:208-642-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4116207Q00000X
207Q00000X
IDN19189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231902Medicaid
ID806957500Medicaid
NPPU5OtherBLUE CROSS-LP
73437OtherBLUE CROSS-REC
8K818OtherBLUE CROSS-GROUP
R108734OtherNORIDIAN
000010147752OtherREGENCE-LP
OR278542Medicaid
000010005775OtherREGENCE-REC
ID0036365Medicaid
D80174720OtherMEDICARE-RAILROAD
R108734OtherNORIDIAN
ID0036365Medicaid