Organization
SUN VALLEY SPORTS MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN WASILWESKI M.D. (PHYSICIAN)
(208) 726-5207
Entity
Organization
Contact information
Practice address
191 5TH ST W, KETCHUM, ID 83340
(208) 726-5207
(208) 726-8948
Mailing address
191 5TH ST W, KETCHUM, ID 83340
(208) 726-5207
(208) 726-8948
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200015728
RR MEDICARE
ID
05
—
805960600
—
ID
Enumeration date
06/14/2006
Last updated
06/17/2008
Update your record
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