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General NPI Number Information
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NPI Number | 1811035090
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Entity Type | Organization
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Legal Business Name | HUNTSMAN ORTHOPAEDIC SURGERY & SPORTS MEDICINEPA
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3300 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7592
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Country | US
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Telephone | 208-522-6662
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Fax | 208-522-0880
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Provider Business Mailing Address
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Address Line | 3300 WASHINGTON PARKWAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7592
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Country | US
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Telephone | 208-522-6662
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Fax | 208-522-0880
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Authorized Official
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Title or Position | PRESIDENT
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Name | CASEY I HUNTSMAN
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Credential | M.D.
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Telephone | 208-522-6662
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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 | M8232
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License Number State | ID
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