Provider Demographics
NPI:1497782759
Name:ORBIT MEDICAL OF IDAHO FALLS INC
Entity Type:Organization
Organization Name:ORBIT MEDICAL OF IDAHO FALLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-713-2020
Mailing Address - Street 1:4516 S 700 E
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8317
Mailing Address - Country:US
Mailing Address - Phone:801-713-2020
Mailing Address - Fax:
Practice Address - Street 1:1976 N WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-1732
Practice Address - Country:US
Practice Address - Phone:208-523-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID003046109-S332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5622520001Medicare NSC