Idaho Falls Family & Sports Medicine
LBN: Tony C Roisum Md Pa
Idaho Falls Family & Sports Medicine is an health care organization with primary practice located at 3360 Washington Pkwy Suite 1, Idaho Falls ID 83404-8333. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty.
Tony C Roisum Md Pa can be contacted via phone (208) 524-3416, or through Roisum, Tony C via phone (208) 524-3416.
Contact Information
Primary practice address
3360 Washington Pkwy Suite 1
Idaho Falls ID 83404-8333
Phone: (208) 524-3416
Fax: (208) 524-3138
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M7389 | Idaho |
| Allopathic & Osteopathic Physicians / Sports Medicine | 207QS0010X | M7389 | Idaho |
Profile Details
| NPI number | 1124115944 |
|---|---|
| LBN Legal business name | Tony C Roisum Md Pa |
| DBA Doing business as | Idaho Falls Family & Sports Medicine |
| Authorized official | Roisum, Tony C Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 5th, 2006 |
| Last updated | May 20th, 2016 - about 8 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124115944 | NPPES |
| Idaho | Other | 000010004286 | BLUE SHIELD |
| Idaho | Other | B5824 | BLUE SHIELD |
| Idaho | Other | DJ475 | BLUE SHIELD |
| Idaho | MEDICAID | 119166700 | BLUE SHIELD |
| Idaho | Other | 185461600 | BLUE SHIELD |
| Idaho | MEDICAID | 502862456001 | BLUE SHIELD |
| Idaho | Other | 23397 | BLUE SHIELD |
| Idaho | MEDICAID | 805076700 | BLUE SHIELD |
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