Organization
IDAHO STATE UNIVERSITY
Active
Other names
Idaho State Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JODI WOTOWEY (HEAD ATHLETIC TRAINER)
(208) 282-3408
Entity
Organization
Contact information
Practice address
921 S 8TH AVE STOP 8173, SPORTS AND ORTHOPAEDIC CENTER, POCATELLO, ID 83209-8173
(208) 282-3408
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
(800) 555-9073
(972) 367-3452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Enumeration date
11/13/2014
Last updated
11/13/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us