1760520951 NPI number — GREGORY E BIDDULPH ORTHOPEDICS

Table of content: (NPI 1760520951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760520951 NPI number — GREGORY E BIDDULPH ORTHOPEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY E BIDDULPH ORTHOPEDICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760520951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 WASHINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDAHO FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83404-7592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-522-6662
Provider Business Mailing Address Fax Number:
208-522-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 WASHINGTON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83404-7592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-522-6662
Provider Business Practice Location Address Fax Number:
208-522-0880
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BIDDULPH
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
208-522-6662

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77075 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: Z4950 . This is a "BUREAU OF MEDICAID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 286007 . This is a "OREGON MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20036025 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010163002 . This is a "BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 29686 . This is a "BXI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8157532 . This is a "OUT OF STATE CLAIMS DEPAR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0027971 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000100000552 . This is a "MEDIVANTAGE BS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 196973 . This is a "ALTIUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 613028 . This is a "BX BS OF VIRIGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7608951 . This is a "EDS OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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