Provider Demographics
NPI:1174790257
Name:SAWTOOTH ORTHOPEDIC & FRACTURE CLINIC, PA
Entity type:Organization
Organization Name:SAWTOOTH ORTHOPEDIC & FRACTURE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELMER
Authorized Official - Middle Name:F
Authorized Official - Last Name:PLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-622-3311
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:208-622-3311
Mailing Address - Fax:208-622-4919
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-622-3311
Practice Address - Fax:208-622-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3574261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1111633Medicaid
IDD73465Medicare UPIN