NPI age
19 years
Enumerated 2006-11-06
● Active Type 2 · Organization
Idaho Orthopedic & Sports Clinic PA
Idaho Orthopedic & Sports Clinic PA is 1 of 61 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Hall
Administrator
Last NPPES update
2015-07-30
Source: monthly bulk 2026-05
How this organization compares
Across 61 active clinic/center providers in Idaho.
NPI age
19 years
↑ 12 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-11Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
560 Memorial Dr
Pocatello, ID 832014073
Mailing address
560 Memorial Dr
Pocatello, ID 832014073
Authorized official
Ryan Hall
Administrator
📞 2082341960
Individual providers at this organization
10 individual providers on file at this primary practice address.
- Kobi Alcocer Specialist/Technologist NPI 1952014714
- Douglas Ashton, ATC Specialist/Technologist NPI 1780963108
- Steve Coker, MD Orthopaedic Surgery NPI 1942294624
- Frank Dimick, ATC, LAT, LPTA Physical Therapy Assistant NPI 1366470031
- Derek Eddie, PA-C Physician Assistant NPI 1346375367
- McKenzie Jemmett, SLP Speech-Language Pathologist NPI 1194109223
- Steven Nelson, PA-C Physician Assistant NPI 1659689362
- Kenneth Newhouse, MD Orthopaedic Surgery NPI 1265425789
- Edward Schwarze, MPT Physical Therapist NPI 1083788764
- Shayna Waldron, SLP Speech-Language Pathologist NPI 1952785172
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 805136500 |
Practice context
Multi-provider organization. 10 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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