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General NPI Number Information
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NPI Number | 1356719108
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Entity Type | Organization
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Legal Business Name | TADJE ORTHOPAEDICS, LLC
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 2365 E GALA ST STE 1
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-515-2654
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Fax | 877-587-3112
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Provider Business Mailing Address
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Address Line | 1940 S BONITO WAY STE 190
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City | MERIDIAN
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State | ID
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Zip | 83642-5618
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Country | US
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Telephone | 208-287-9420
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Fax |
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Authorized Official
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Title or Position | PROVIDER RELATIONS MGR
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Name | LACEY MADRIGAL
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Credential |
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Telephone | 208-515-2654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M-9901
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License Number State | ID
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