IDAHO FALLS PEDIATRICS NPI 1366560971

NPI Information

IDAHO FALLS PEDIATRICS is an adolescent medicine pediatrics in Idaho Falls, ID. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. IDAHO FALLS PEDIATRICS NPI is 1366560971. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2375 CORONADO ST
IDAHO FALLS, ID
ZIP 83404-407
Phone: (208) 522-4600
Fax: (208) 552-7521

The provider's authorized official is Ron Wade Porter .
The authorized official title is Owner and has the following contact phone number (208) 522-4600.

The CLIA number assigned to this NPI record is 13D0969818 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/26/2007 and was last updated on 8/22/2020.

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:

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