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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