| NPI | 1477965952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY M FORD Owner 208-478-4522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID M-12085) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2022-07-21 |