Organization
IDAHO PHYSICAL MEDICINE AND REHABILITATION PA
Active
Parent organization
IDAHO PHYSICIAL MEDICINE AND REHABILITATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
IDAHO PHYSICIAL MEDICINE AND REHABILITATION
Authorized official
KATE A SHELTON (ADMINISTRATOR)
(208) 287-6558
Entity
Organization
Contact information
Practice address
3551 E OVERLAND ROAD, MERIDIAN, ID 83642
(208) 884-1333
Mailing address
PO BOX 1128, BOISE, ID 83701-1128
(208) 489-4016
(208) 489-4015
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808002500
—
ID
01
—
P00612157
RAILROAD MEDICARE
ID
Enumeration date
08/29/2007
Last updated
06/05/2014
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