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Organization
HOSPITAL MEDICINE ASSOCIATES OF IDAHO PC
Active
Organization
HOSPITAL MEDICINE ASSOCIATES OF IDAHO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASEN W. GUNDERSEN MD (PRESIDENT)
(800) 424-3672
Entity
Organization
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 459-4641
Mailing address
14050 NW 14TH ST, SUITE 190, SUNRISE, FL 33323-2865
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/19/2016
Last updated
08/05/2016
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