IDAHO STATE SPORTS MEDICINE
NPI 1801292115
Family Medicine in Pocatello, ID

Active since November 13, 2014
921 S 8TH AVE STOP 8173, SPORTS AND ORTHOPAEDIC CENTER, POCATELLO, ID 83209(208) 282-3408 Get Directions Write a Review

NPPES record last updated: November 13, 2014. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Family Medicine

About IDAHO STATE SPORTS MEDICINE

This page provides the complete NPI Profile along with additional information for Idaho State Sports Medicine, a primary care provider established in Pocatello, Idaho operating as a Family Medicine. The healthcare provider is registered in the NPI registry with number 1801292115 assigned on November 2014. The practitioner's primary taxonomy code is 207Q00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Idaho State Sports Medicine. The authorized official of this NPI record is Jodi Wotowey (Head Athletic Trainer)

NPI
1801292115 Verify this NPI
Provider Legal Name
IDAHO STATE UNIVERSITY
Other Organization Name
IDAHO STATE SPORTS MEDICINE
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
921 S 8TH AVE STOP 8173 SPORTS AND ORTHOPAEDIC CENTER POCATELLO, ID 83209
Location Phone
(208) 282-3408
Mailing Address
5050 SPRING VALLEY RD DALLAS, TX 75244
Mailing Phone
(800) 555-9073
Mailing Fax
(972) 367-3452
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-13-2014
Last Update Date
11-13-2014
Code Navigator

A primary care provider (PCP) like Idaho State Sports Medicine sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
Taxonomy 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.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207QS0010XAllopathic & Osteopathic Physicians

Family Medicine
Sports Medicine

 
2207X00000XAllopathic & Osteopathic Physicians

Orthopaedic Surgery

 
3207XX0005XAllopathic & Osteopathic Physicians

Orthopaedic Surgery
Sports Medicine

 

Group Taxonomy 193400000X MULTIPLE SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

JODI WOTOWEY

Authorized Official Title
HEAD ATHLETIC TRAINER
Authorized Official Phone
(208) 282-3408

Reviews for IDAHO STATE SPORTS MEDICINE

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Other Providers at the Same Location


The following 2 providers are registered at the same or a nearby location.

Specialist/Technologist (Athletic Trainer)
921 S 8TH AVE STOP 8173
POCATELLO, ID 83209
Specialist/Technologist (Athletic Trainer)
921 S 8TH AVE STOP 8173
POCATELLO, ID 83209

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1801292115, enumerated as an "organization" on November 13, 2014.

The provider is located at 921 S 8TH AVE STOP 8173 SPORTS AND ORTHOPAEDIC CENTER POCATELLO, ID 83209 and the phone number is (208) 282-3408.

Family Medicine with taxonomy code 207Q00000X.