Provider Demographics
NPI:1891734729
Name:IDAHO HAND AND WRIST
Entity Type:Organization
Organization Name:IDAHO HAND AND WRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-287-1110
Mailing Address - Street 1:1520 W STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4038
Mailing Address - Country:US
Mailing Address - Phone:208-287-1110
Mailing Address - Fax:208-287-2010
Practice Address - Street 1:1520 W STATE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4038
Practice Address - Country:US
Practice Address - Phone:208-287-1110
Practice Address - Fax:208-287-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9105207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5625420001Medicare NSC
ID1378979Medicare PIN
IDI17562Medicare UPIN