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NPI Code Detail

MEDICARE: INTERMOUNTAIN EMERGENCY PHYSICIANS

MEDICARE: INTERMOUNTAIN EMERGENCY PHYSICIANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28H997OTHERIDBLUE CROSS GROUP #

General Provider Information

NPI Number : 1124005467
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERMOUNTAIN EMERGENCY PHYSICIANS
Provider Business Mailing Address
First Line : PO BOX 1647
Second Line : 2860 CHANNING WAY SUITE 115
City : IDAHO FALLS
State : ID
Zip : 83403-1647
Country : US
Telephone Number : 208-535-4130
Fax Number : 208-535-4125
Provider Business Practice Location Address
First Line : 3100 CHANNING WAY
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-7533
Country : US
Telephone Number : 208-535-4130
Fax Number : 208-535-4125
Authorized Official
Title or Position : MANAGING PARTNER
Name : MATTHEW R. GRIGGS
Credential : MD
Telephone Number : 208-535-4103
Provider Enumeration Date : 12/28/2005
Last Update Date : 10/05/2021

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Directions to “INTERMOUNTAIN EMERGENCY PHYSICIANS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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