| Idaho Sports & Spine Pllc | |
|
950 Hospital Way Ste A Pocatello ID 83201-2789 | |
| (208) 478-4522 | |
| (208) 478-2935 |
| Full Name | Idaho Sports & Spine Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 950 Hospital Way, Pocatello, Idaho |
| Authorized Official Name and Position | Stephen Hansen (OWNER) |
| Authorized Official Contact | 2084784522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Sports & Spine Pllc 950 Hospital Way Ste A Pocatello ID 83201-2789 Ph: (208) 478-4522 | Idaho Sports & Spine Pllc 950 Hospital Way Ste A Pocatello ID 83201-2789 Ph: (208) 478-4522 |
| NPI Number | 1033417035 |
|---|---|
| Provider Enumeration Date | 03/01/2011 |
| Last Update Date | 11/04/2019 |
| Medicare PECOS PAC ID | 8426234345 |
|---|---|
| Medicare Enrollment ID | O20110510000817 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033417035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | O-0400 (Idaho) | Primary |
| Provider Name | Stephen M Hansen |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1164491460 PECOS PAC ID: 9739149709 Enrollment ID: I20121220000238 |
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