Organization
IDAHO PHYSICIAN SERVICES INC.
Active
Organization
IDAHO PHYSICIAN SERVICES INC.
Active
Other names
East Falls Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS JOSEPH (VP)
(615) 373-7630
Entity
Organization
Contact information
Practice address
3200 CHANNING WAY STE A205, IDAHO FALLS, ID 83404-7586
(208) 535-4580
(208) 535-4520
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 373-7600
(866) 346-1426
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154957
BLUE SHIELD
ID
05
—
1902841893
—
MT
05
—
1902841893
—
WY
05
—
807418100
—
ID
01
—
8M826
BLUECROSS OF ID
ID
Enumeration date
06/17/2006
Last updated
01/02/2023
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