Organization
HOSPITAL MEDICINE ASSOCIATES OF IDAHO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASEN W. GUNDERSEN MD (PRESIDENT)
(800) 424-3672
Entity
Organization
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 459-4641
Mailing address
14050 NW 14TH ST, SUITE 190, SUNRISE, FL 33323-2865
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
05/19/2016
Last updated
08/05/2016
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