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Contact Information

SUN VALLEY SPORTS MEDICINE, P.A.
191 5TH ST W
KETCHUM, ID83340
 Phone: 208-726-5207
 Fax: 208-726-8948
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Sports Medicine

207XX0005X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for SUN VALLEY SPORTS MEDICINE PA · (Female)

NPI # 1124061163
Status Active
Credentials
Entity Individual
Enumeration date 06/14/2006
Last updated 06/17/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • ID Medicaid 805960600
  • ID Other 200015728 RR MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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