Organization
IDAHO ORTHOPAEDICS AND SPORTS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. 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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
ID
Other
Enumeration date
11/01/2006
Last updated
07/10/2014
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