Provider Demographics
NPI:1396900742
Name:KIMBERLY A. VORSE MD PC
Entity type:Organization
Organization Name:KIMBERLY A. VORSE MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:VORSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-726-0000
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-5000
Mailing Address - Country:US
Mailing Address - Phone:208-342-7700
Mailing Address - Fax:208-342-8003
Practice Address - Street 1:380 WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-342-7700
Practice Address - Fax:208-342-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7028261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001872900Medicaid
IDG06089Medicare UPIN
ID11346461Medicare PIN