Provider Demographics
NPI:1306090030
Name:EMERGENCY ORTHOPEDIC SERVICES OF IDAHO PLLC
Entity type:Organization
Organization Name:EMERGENCY ORTHOPEDIC SERVICES OF IDAHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:208-227-1100
Mailing Address - Street 1:2321 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7407
Mailing Address - Country:US
Mailing Address - Phone:208-227-1100
Mailing Address - Fax:208-227-1087
Practice Address - Street 1:2321 CORONADO ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7407
Practice Address - Country:US
Practice Address - Phone:208-227-1100
Practice Address - Fax:208-227-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty