Healthcare Provider Details

I. General information

NPI: 1427273853
Provider Name (Legal Business Name): KIMBERLY A VORSE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 WASHINGTON AVE SUITE 201
KETCHUM ID
83340
US

IV. Provider business mailing address

PO BOX 5000
KETCHUM ID
83340-5000
US

V. Phone/Fax

Practice location:
  • Phone: 208-726-0000
  • Fax: 208-726-0000
Mailing address:
  • Phone: 208-726-0000
  • Fax: 208-725-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberM7028
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM7028
License Number StateID

VIII. Authorized Official

Name: DR. KIMBERLY ANN VORSE
Title or Position: CEO
Credential: MD
Phone: 208-726-0000