Provider Demographics
NPI:1497774772
Name:ANTHONY MAISIN BUONCRISTIANI, MD
Entity Type:Organization
Organization Name:ANTHONY MAISIN BUONCRISTIANI, MD
Other - Org Name:SAWTOOTH ORTHOPEDIC AND SPORTS MEDICINE, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUONCRISTIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-622-3312
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83353-1332
Mailing Address - Country:US
Mailing Address - Phone:208-622-3312
Mailing Address - Fax:208-622-4919
Practice Address - Street 1:660 2ND AVE S
Practice Address - Street 2:UNIT A
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-622-3312
Practice Address - Fax:208-622-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807513700Medicaid
IDDF6382OtherRR MEDICARE
ID1369885Medicare PIN
ID807513700Medicaid