Organization
IDAHO ORTHOTIC PROSTHETIC SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA K MORRISON (CONTRACT SPECIALIST)
(503) 765-5081
Entity
Organization
Contact information
Practice address
425 S WHITLEY DR STE 431, FRUITLAND, ID 83619-2611
(208) 884-1294
(208) 884-1293
Mailing address
8880 SW NIMBUS AVE STE A, BEAVERTON, OR 97008-7111
(503) 765-5081
(503) 765-5081
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148826
BLUE SHIELD IDAHO
ID
05
—
277882
—
OR
05
—
807031400
—
ID
01
—
8K537
TRUE BLUE BLUE CROSS IDAH
ID
Enumeration date
01/26/2007
Last updated
06/30/2020
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