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General NPI Number Information
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NPI Number | 1881228591
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Entity Type | Organization
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Legal Business Name | IDAHO PROSTHETICS & ORTHOTICS, INC.
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 476 CHENEY DR W STE 160
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City | TWIN FALLS
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State | ID
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Zip | 83301-3790
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Country | US
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Telephone | 208-358-2012
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Fax | 208-732-1230
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Provider Business Mailing Address
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Address Line | 2595 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7516
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Country | US
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Telephone | 208-523-9000
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Fax | 208-523-9039
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANNETTE WRIGHT
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Credential |
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Telephone | 208-478-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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