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General NPI Number Information
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NPI Number | 1902841893
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Entity Type | Organization
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Legal Business Name | IDAHO PHYSICIAN SERVICES INC.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 3200 CHANNING WAY STE A205
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7586
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Country | US
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Telephone | 208-535-4580
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Fax | 208-535-4520
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4525
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Country | US
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Telephone | 615-373-7600
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Fax | 866-346-1426
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Authorized Official
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Title or Position | VP
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Name | LOUIS JOSEPH
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Credential |
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Telephone | 615-373-7630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology 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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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