Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Idaho State University

Organization Family Medicine Physician · NPI 1801292115

Idaho State University is a Family Medicine Physician in Pocatello, Idaho. Registered with an NPI since 2014.

In the registry since
2014
Specialties on file
4

Practice location Address checks out

921 S 8th Ave Stop 8173 Sports And Orthopaedic Center
Pocatello, ID 83209-8173
Phone: (208) 282-3408
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X
Orthopaedic Surgery Physician Taxonomy 207X00000X
Sports Medicine (Orthopaedic Surgery) Physician Taxonomy 207XX0005X

Record details

NPI number1801292115
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jodi Wotowey — Head Athletic Trainer · (208) 282-3408
Other names Idaho State Sports Medicine
NPI enumeratedNovember 13, 2014
Last updated in NPPESNovember 13, 2014
Mailing address5050 Spring Valley Rd, Dallas, TX 75244-3995

Other providers in Pocatello