Provider Demographics
NPI:1902841893
Name:IDAHO PHYSICIAN SERVICES INC.
Entity Type:Organization
Organization Name:IDAHO PHYSICIAN SERVICES INC.
Other - Org Name:EAST FALLS ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7630
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4525
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:866-346-1426
Practice Address - Street 1:3200 CHANNING WAY STE A205
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7586
Practice Address - Country:US
Practice Address - Phone:208-535-4580
Practice Address - Fax:208-535-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010154957OtherBLUE SHIELD
WY1902841893Medicaid
MT1902841893Medicaid
ID807418100Medicaid
ID8M826OtherBLUECROSS OF ID
ID000010154957OtherBLUE SHIELD
ID807418100Medicaid