| NPI | 1801292115 |
|---|---|
| Doing Business As | IDAHO STATE SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | JODI WOTOWEY Head Athletic Trainer 208-282-3408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207X00000X Orthopaedic Surgery | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2014-11-13 |