Organization
IDAHO ORTHOPEDIC & SPORTS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN HALL (ADMINISTRATOR)
(208) 234-1960
Entity
Organization
Contact information
Practice address
560 MEMORIAL DR, POCATELLO, ID 83201-4073
(208) 234-1969
(208) 233-5033
Mailing address
560 MEMORIAL DR, POCATELLO, ID 83201-4073
(208) 234-1969
(208) 233-5033
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805136500
—
ID
Enumeration date
11/06/2006
Last updated
07/30/2015
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