IDAHO SPORTS MEDICINE INSTITUTE, PA


Address: 1188 University Dr, Boise, ID 83706-3009
Phone: 2083368250

IDAHO SPORTS MEDICINE INSTITUTE, PA (NPI# 1154356624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1154356624
Entity Type Organization
Organization Name IDAHO SPORTS MEDICINE INSTITUTE, PA
Practice Address 1188 University Dr
Boise
ID 83706-3009
Practice Telephone 2083368250
Practice Fax Number 2083459514
Mailing Telephone 2083368250
Mailing Fax Number 2083459514
Enumeration Date 2006-07-12
Last Update Date 2011-02-25
Authorized Official Name JENNIFER R. MILLIER (OWNER/PARTNER)
Authorized Official Telephone 2083368250
Authorized Official Credential M.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 204C00000X Neuromusculoskeletal Medicine, Sports Medicine N/A FOR GROUP Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
ID GROUP # 29145 REGENCE BLUE SHIELD 01
ID BLUE CROSS OF IDAHO GROUP 8628-0 01
ID 805993900 05

Office Location

Street Address 1188 UNIVERSITY DR
City BOISE
State ID
Zip Code 83706-3009

Providers in the same location

NPI Name Taxonomy Address Enumeration
1063418903 George A. Wade Orthopaedic Surgery 1188 University Dr, Boise, ID 83706-3009 2005-06-24
1538359815 Korene D Mayo Specialist/Technologist 1188 University Dr, Boise, ID 83706-3009 2007-08-01
1184699787 Elizabeth Greenway Schoenfeld Physical Therapist 1188 University Dr, Boise, ID 83706-3009 2006-02-17
1609872241 Kristin K Hulquist Physical Therapist 1188 University Dr, Boise, ID 83706 2005-06-27
1639175276 Bradford R. Page Physical Therapist 1188 University Dr, Boise, ID 83706 2005-06-27
1386640928 Linda Hammann Physical Therapist 1188 University Dr, Boise, ID 83706-3009 2005-06-27
1245236983 Jennifer Rawlings Miller Orthopaedic Surgery 1188 University Dr, Boise, ID 83706 2005-06-27
1043216823 Scot B Scheffel Family Medicine 1188 University Dr, Boise, ID 83706 2005-06-24
1033115803 Kirk J Lewis Orthopaedic Surgery 1188 University Dr, Boise, ID 83706 2005-06-24

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1164993010 Brette Marie Stephenson Counselor 1529 Belmont St., Boise, ID 83706 2018-12-17
1295249241 Boise of Cascadia, LLC Skilled Nursing Facility 6000 W. Denton St., Boise, ID 83706 2017-11-29
1174035638 Zacharia Njoroge Physician Assistant 1055 N Curtis Rd 6th Floor, Boise, ID 83706 2017-10-24
1740708965 Total Renal Care Inc Clinic/Center 1070 N Curtis Rd Ste 125, Boise, ID 83706 2017-09-08
1023532173 Amber Frisch Massage Therapist 2509 S Gekeler Lane, Boise, ID 83706 2017-07-31
1952768145 Katie Garcin Specialist 1407 E Boston Dr, Boise, ID 83706 2016-01-20
1770950677 Kathryn Bender Counselor 1205 N Garden St, Boise, ID 83706 2015-08-26
1457751802 Sabrina Shumar Physician Assistant 901 N Curtis Rd Ste 501, Boise, ID 83706 2014-09-03
1831525070 Katie Joy Wilson Social Worker 333 W. Rossi St. #300, Boise, ID 83706 2013-09-19
1609208610 Christine Lea Eden Surgery 1075 N Curtis Rd Ste 101, Boise, ID 83706 2013-07-31
Find all providers in zip 83706

Taxonomy Information

Taxonomy Code 204C00000X
Grouping Allopathic & Osteopathic Physicians
Classification Neuromusculoskeletal Medicine, Sports Medicine

Taxonomy Definition

Definition to come.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1053481366 Suzanne Michelle Ring Neuromusculoskeletal Medicine, Sports Medicine 600 N Robbins Rd, Ste 100, Boise, ID 83702-4566 2006-11-08

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1134135775 Gary C Walker Neuromusculoskeletal Medicine, Sports Medicine 2319 Coronado St, Idaho Falls, ID 83404-7407 2006-08-01
1447773023 Nina R Beckwell Neuromusculoskeletal Medicine, Sports Medicine 321 W Main St, Grangeville, ID 83530-1917 2017-07-25
1790872109 Walker Spine and Sports Specialists Neuromusculoskeletal Medicine, Sports Medicine 2319 Coronado St, Idaho Falls, ID 83404-7407 2006-10-06
1730195298 Eric D Walker Neuromusculoskeletal Medicine, Sports Medicine 2319 Coronado St, Idaho Falls, ID 83404-7407 2006-08-01
1114961166 Mark Scott Williams Neuromusculoskeletal Medicine, Sports Medicine 215 E Hawaii Ave, Nampa, ID 83686-6011 2006-06-16

Competitor

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City BOISE
Zip Code 83706

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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