| NPI | 1356719108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY MADRIGAL Provider Relations Mgr 208-515-2654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-9901) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2023-02-27 |