Healthcare Provider Details

I. General information

NPI: 1821910472
Provider Name (Legal Business Name): JENSEN ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2996 N AJAX AVE
EAGLE ID
83616-1077
US

IV. Provider business mailing address

2996 N AJAX AVE
EAGLE ID
83616-1077
US

V. Phone/Fax

Practice location:
  • Phone: 208-605-3662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAY JENSEN
Title or Position: OWNER
Credential: MD
Phone: 208-605-3662