Healthcare Provider Details

I. General information

NPI: 1164218269
Provider Name (Legal Business Name): APEX ADVANCED SPINE & PAIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 E ST LUKES ST
MERIDIAN ID
83642
US

IV. Provider business mailing address

10400 W OVERLAND RD UNIT 287
BOISE ID
83709-1433
US

V. Phone/Fax

Practice location:
  • Phone: 208-992-4111
  • Fax:
Mailing address:
  • Phone: 303-903-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON WILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 303-903-8003