MEDICARE: IDAHO PROSTHETICS & ORTHOTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	335E00000X	Prosthetic/Orthotic Supplier		ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760514780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDAHO PROSTHETICS & ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	2595 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7516
Country	:	US
Telephone Number	:	208-523-9000
Fax Number	:	208-523-9039

Provider Business Practice Location Address
First Line	:	2595 CHANNING WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7516
Country	:	US
Telephone Number	:	208-523-9000
Fax Number	:	208-523-9039

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANNETTE WRIGHT
Credential	:
Telephone Number	:	208-478-8800

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	03/03/2020

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