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General NPI Number Information
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NPI Number | 1821036724
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN SPINE AND ORTHOPEDICS, PC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 1411 FALLS AVE E SUITE 1301
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City | TWIN FALLS
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State | ID
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Zip | 83301-3455
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Country | US
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Telephone | 208-732-0067
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Fax | 208-732-3195
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Provider Business Mailing Address
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Address Line | 1411 FALLS AVE E STE 1301
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City | TWIN FALLS
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State | ID
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Zip | 83301-3467
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Country | US
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Telephone | 208-732-0067
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Fax | 208-732-3195
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Authorized Official
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Title or Position | OWNER
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Name | DAVID M CHRISTENSEN
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Credential | MD
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Telephone | 208-732-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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