Tony C Roisum Md Pa, NPI 1124115944
Family Medicine Physician in Idaho Falls, ID, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1124115944
NPI Entity Type Organization
Provider Name Tony C Roisum Md Pa
Doing Business As
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 3360 Washington Pkwy, Suite 1, Idaho Falls, ID, US
Provider Mailing Address 3360 Washington Pkwy, Suite 1, Idaho Falls, ID, US, 834048333
Is Sole Proprietor? No
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Organization Official

Official Name MD Tony C Roisum
Official Position OWNER / PRESIDENT
Phone 208-524-3416

Group Taxonomy

Taxonomy Code 193200000X
Taxonomy Name 193200000X MULTI-SPECIALTY GROUP
Definition A business group of one or more individual practitioners, who practice with different areas of specialization.

Primary Taxonomy

Taxonomy Code

207Q00000X

Taxonomy Name Family Medicine Physician
Classification

Family Medicine

Group

Allopathic & Osteopathic Physicians

License No. M7389
License State ID
Description Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Other Organization Name

Idaho Falls Family & Sports Medicine
Doing Business As

Business Address

Tony C Roisum Md Pa
3360 Washington Pkwy
Suite 1

Idaho Falls, ID, US

Phone: 208-524-3416
Fax: 208-524-3138

Mailing Address

Tony C Roisum Md Pa
3360 Washington Pkwy
Suite 1
Idaho Falls, ID, US
ZIP 834048333
Phone: 208-524-3416
Fax: 208-524-3138

Secondary Taxonomies

Taxonomy Code Group Classification License No. State Primary?

207QS0010X

Allopathic & Osteopathic Physicians

Family Medicine

M7389 ID No

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
000010004286 ID BLUE SHIELD 01
B5824 BLUE CROSS 01
DJ475 ID BLUE CROSS 01
119166700 WY MEDICAID 05
185461600 ID US DEPT OF LABOR 01
502862456001 UT MEDICAID 05
23397 BLUE SHIELD 01
805076700 ID MEDICAID 05

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Organization

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Organization

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1230 Northwood Center Ct.

Ste. B

Coeur D'alene, ID

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