Healthcare Provider Details

I. General information

NPI: 1336540020
Provider Name (Legal Business Name): BIDDULPHANDHUNTSMANORTHOPEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WASHINGTON PKWY
IDAHO FALLS ID
83404-7592
US

IV. Provider business mailing address

3300 WASHINGTON PKWY
IDAHO FALLS ID
83404-7592
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-6662
  • Fax:
Mailing address:
  • Phone: 208-522-6662
  • Fax: 208-522-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. JUDY RIETH
Title or Position: BILLING MANAGER
Credential:
Phone: 208-522-6662