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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, P.A.

NPI # 1124061163
LBN Legal business name SUN VALLEY SPORTS MEDICINE, P.A.
Authorized official STEPHEN WASILWESKI - (PHYSICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 06/14/2006
Last updated 06/17/2008 - About 18 years ago
Identifiers
ID Medicaid 805960600
ID Other 200015728 RR MEDICARE
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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