Organization
EAST IDAHO ORTHOPAEDICS PLLC
Active
Organization
EAST IDAHO ORTHOPAEDICS PLLC
Active
Other names
Liljenquist & Redd Orthopedic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALEXIS L BERGESON (PRACTICE MANAGER)
(208) 932-4133
Entity
Organization
Contact information
Practice address
3405 MERLIN DR, IDAHO FALLS, ID 83404-7430
(208) 522-3355
(208) 522-6019
Mailing address
3405 MERLIN DR, IDAHO FALLS, ID 83404-7430
(208) 522-3355
(208) 522-6019
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
M-10197
ID
207X00000X
Orthopaedic Surgery Physician
Primary
M-9781
ID
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M-9781
ID
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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