Provider Demographics
NPI:1427273853
Name:KIMBERLY A VORSE MD PC
Entity type:Organization
Organization Name:KIMBERLY A VORSE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VORSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-726-0000
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-5000
Mailing Address - Country:US
Mailing Address - Phone:208-726-0000
Mailing Address - Fax:208-725-0028
Practice Address - Street 1:380 WASHINGTON AVE SUITE 201
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-0000
Practice Address - Fax:208-726-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7028207RS0012X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001872900 1111Medicaid
IDG06089Medicare UPIN
ID001872900 1111Medicaid