NPIMap

Organization Active NPI

Idaho Sports Medicine Institute

  • Physical Therapy Clinic/Center
  • Boise, ID
National Provider Identifier
1700180445
Registry record updated Jan 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT-1825 Issued in ID
Legal business name
IDAHO SPORTS MEDICINE INSTITUTE
Practice address
1188 W University Dr
Boise, ID 83706-3009
Phone
(208) 336-8250
Fax
(208) 345-9514
NPI assigned
Jan 10, 2011
Last updated
Jan 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roy Tweedle
Title
Business Manager
Phone
(208) 336-8250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT-1825 ID Primary

Addresses

Primary practice location

1188 W University Dr
Boise, ID 83706-3009

Mailing address

1188 W University Dr
Boise, ID 83706-3009
Phone (208) 336-8250

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294617600000",
    "number": "1700180445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1188 W UNIVERSITY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063009",
            "telephone_number": "208-336-8250",
            "fax_number": "208-345-9514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1188 W UNIVERSITY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063009",
            "telephone_number": "208-336-8250",
            "fax_number": "208-345-9514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO SPORTS MEDICINE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-10",
        "last_updated": "2011-01-10",
        "status": "A",
        "authorized_official_last_name": "TWEEDLE",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "208-336-8250"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ID",
            "license": "PT-1825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.