Family Medicine
IDAHO STATE UNIVERSITY
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1801292115 · enumerated 2014-11-13 · record updated 2014-11-13. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: JODI WOTOWEY, Head Athletic Trainer · (208) 282-3408
Other names: IDAHO STATE SPORTS MEDICINE
Addresses and phones
- Mailing address 5050 SPRING VALLEY RD, DALLAS, TX, 75244-3995 (800) 555-9073 Fax (972) 367-3452 Google Maps Apple Maps OpenStreetMap
- Practice location 921 S 8TH AVE STOP 8173, SPORTS AND ORTHOPAEDIC CENTER, POCATELLO, ID, 83209-8173 (208) 282-3408 Google Maps Apple Maps OpenStreetMap
Specialties
- Family Medicine, Sports Medicine 207QS0010X
- Orthopaedic Surgery 207X00000X
- Orthopaedic Surgery, Sports Medicine 207XX0005X
- Family Medicine 207Q00000X · Primary
In this directory
Locations and evidence
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Practice location
POCATELLO, ID, 832098173
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.