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Contact Information

WALKER SPINE AND SPORTS SPECIALISTS
2319 CORONADO ST
IDAHO FALLS, ID83404-7407
 Phone: 208-227-1200
 Fax: 208-227-1212
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neuromusculoskeletal Medicine, Sports Medicine

204C00000X 12 Physician/Osteopathic Manipulative Medicine
Indicates primary specialty

NPI Profile & details for WALKER SPINE AND SPORTS SPECIALISTS

NPI Number 1790872109
LBN Legal business name WALKER SPINE AND SPORTS SPECIALISTS
Authorized official GARY WALKER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/06/2006
Last updated 03/10/2016 - About 10 years ago
Identifiers
ID License # E65389
ID Medicaid 806811100
ID Other 8H989 BLUE CROSS
ID Other DA4495 RAILROAD MEDICARE
ID Other 000010140195 REGENCE BLUE SHIELD
ID Other 204221200 US DEPT OF LABOR
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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