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TONY C ROISUM MD PA NPI 1124115944


NPI Information

NPI: 1124115944
Provider Name: TONY C ROISUM MD PA

Doing Business As: IDAHO FALLS FAMILY & SPORTS MEDICINE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 13D0936394

Address:
3360 WASHINGTON PKWY
SUITE 1
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 524-3416
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TONY C ROISUM MD PA is a family medicine in Idaho Falls, ID. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TONY C ROISUM MD PA NPI is 1124115944. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Idaho Falls Family & Sports Medicine.

The provider's business location address is:

3360 WASHINGTON PKWY
SUITE 1
IDAHO FALLS, ID
ZIP 83404-333
Phone: (208) 524-3416
Fax: (208) 524-3138

The provider's authorized official is Tony C Roisum .
The authorized official title is Owner / President and has the following contact phone number (208) 524-3416.

The CLIA number assigned to this NPI record is 13D0936394 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/5/2006 and was last updated on 5/20/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207QS0010XFamily MedicineSports MedicineM7389IDAHONo
2207Q00000XFamily MedicineM7389IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1185461600OTHERIDAHOUS DEPT OF LABOR
2B5824OTHERBLUE CROSS
31138391MEDICARE ID-TYPE UNSPECIFIEDIDAHO
4DJ475OTHERIDAHOBLUE CROSS
5080120741MEDICARE ID-TYPE UNSPECIFIEDIDAHORAILROAD MEDICARE
6119166700MEDICAIDWYOMING
7000010004286OTHERIDAHOBLUE SHIELD
8F29375MEDICARE UPINIDAHO
9502862456001MEDICAIDUTAH
101138391MEDICARE PIN
1123397OTHERBLUE SHIELD
12805076700MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.