# UPPER VALLEY ORTHOPEDICS, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184799298
- **Authorized official:** DR. MICHAEL J LARSON MD (OWNER)
- **Authorized official phone:** (208) 356-9550

## Contact information

- **Practice address:** 360 E MAIN ST, REXBURG, ID 83440-2015
- **Practice address phone:** (208) 356-9550
- **Practice address fax:** (208) 356-8023
- **Mailing address:** 360 E MAIN ST, REXBURG, ID 83440-2015
- **Mailing address phone:** (208) 356-9550
- **Mailing address fax:** (208) 356-8023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M5158 | ID | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 11/19/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 808017600 | — | ID |