| Idaho Falls Family & Sports Medicine | |
|
3360 Washington Pkwy Suite 1 Idaho Falls ID 83404-8333 | |
| (208) 524-3416 | |
| (208) 524-3138 |
| Full Name | Idaho Falls Family & Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 3360 Washington Pkwy, Idaho Falls, Idaho |
| Authorized Official Name and Position | Tony C Roisum (OWNER / PRESIDENT) |
| Authorized Official Contact | 2085243416 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Falls Family & Sports Medicine 3360 Washington Pkwy Suite 1 Idaho Falls ID 83404-8333 Ph: (208) 524-3416 | Idaho Falls Family & Sports Medicine 3360 Washington Pkwy Suite 1 Idaho Falls ID 83404-8333 Ph: (208) 524-3416 |
| NPI Number | 1124115944 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 05/20/2016 |
| Medicare PECOS PAC ID | 5991094864 |
|---|---|
| Medicare Enrollment ID | O20160516001966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124115944 | NPI | - | NPPES |
| 000010004286 | Other | ID | BLUE SHIELD |
| B5824 | Other | BLUE CROSS | |
| DJ475 | Other | ID | BLUE CROSS |
| 119166700 | Medicaid | WY | |
| 185461600 | Other | ID | US DEPT OF LABOR |
| 502862456001 | Medicaid | UT | |
| 23397 | Other | BLUE SHIELD | |
| 805076700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M7389 (Idaho) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | M7389 (Idaho) | Secondary |
Shane G Machen, Do Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1995 E 17th St Ste A, Idaho Falls, ID 83404 Phone: 208-522-7666 Fax: 208-524-2821 | |
Physician Skin Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 730 S Woodruff Ave, Idaho Falls, ID 83401 Phone: 208-542-9111 | |
Family First Medical Center, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3614 Washington Pkwy, Idaho Falls, ID 83404 Phone: 208-552-7700 Fax: 208-552-1783 | |
Imed Hrs Idaho Falls Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 801-507-3500 | |
Neville Spinal Balance Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2145 West Broadway Street, Idaho Falls, ID 83402 Phone: 208-522-3130 | |
R.k. Arbon, M.d., P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2860 Channing Way, Suite 116, Idaho Falls, ID 83404 Phone: 208-529-0575 Fax: 208-528-0223 |