Organization
SHOULDER & KNEE CENTER, PA
Active
Organization
SHOULDER & KNEE CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ANDARY M.D. (OWNER)
(208) 524-5633
Entity
Organization
Contact information
Practice address
2035 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 524-5633
(208) 524-1045
Mailing address
2035 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 524-5633
(208) 524-1045
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M8490
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139745
BLUE SHIELD OF IDAHO
ID
05
—
806411300
—
ID
01
—
P00020270
TRAVELERS MEDICARE
ID
Enumeration date
02/25/2008
Last updated
09/02/2008
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