MEDICARE: INTERMOUNTAIN ORTHOPAEDICS SPECIALISTS

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	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CN7062	OTHER	ID	MEDICARE RAILROAD
6	CK7632	OTHER	ID	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88815	OTHER	ID	BLUE CROSS OF IDAHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000010006178	OTHER	ID	BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902913379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN ORTHOPAEDICS SPECIALISTS

Provider Business Mailing Address
First Line	:	600 N ROBBINS RD
Second Line	:	STE 401
City	:	BOISE
State	:	ID
Zip	:	83702-4539
Country	:	US
Telephone Number	:	208-383-0201
Fax Number	:	208-489-4300

Provider Business Practice Location Address
First Line	:	600 N ROBBINS RD
Second Line	:	STE 100
City	:	BOISE
State	:	ID
Zip	:	83702-4539
Country	:	US
Telephone Number	:	208-383-0201
Fax Number	:	208-489-4300

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SCOTT R BROWN
Credential	:
Telephone Number	:	208-489-4229

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	09/08/2008

Similar Medicare Providers

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Practice Location Address:

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83702-4539

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1871652867 — TRACIE SNYDER CFA
Practice Location Address:

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83702-4539

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1861545832 — MRS. SHERI MOSS HARRISON MPT, CWS
Practice Location Address:

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83702-4539

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Directions to “INTERMOUNTAIN ORTHOPAEDICS SPECIALISTS ” Practice Location

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