Provider Demographics
NPI:1902913379
Name:INTERMOUNTAIN ORTHOPAEDICS SPECIALISTS
Entity Type:Organization
Organization Name:INTERMOUNTAIN ORTHOPAEDICS SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-489-4229
Mailing Address - Street 1:600 N ROBBINS RD
Mailing Address - Street 2:STE 401
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4539
Mailing Address - Country:US
Mailing Address - Phone:208-383-0201
Mailing Address - Fax:208-489-4300
Practice Address - Street 1:600 N ROBBINS RD
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4539
Practice Address - Country:US
Practice Address - Phone:208-383-0201
Practice Address - Fax:208-489-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID88815OtherBLUE CROSS OF IDAHO
ID805467800Medicaid
IDCN7062OtherMEDICARE RAILROAD
ID000010006178OtherBLUE SHIELD
ID002683100Medicaid
IDCK7632OtherMEDICARE RAILROAD
ID0400850001Medicare NSC
IDCK7632OtherMEDICARE RAILROAD