Healthcare Provider Details

I. General information

NPI: 1417267329
Provider Name (Legal Business Name): IDAHO PAIN CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 SUPERIOR ST STE 101
SANDPOINT ID
83864-2742
US

IV. Provider business mailing address

1327 W SUPERIOR ST STE 101
SANDPOINT ID
83864-2742
US

V. Phone/Fax

Practice location:
  • Phone: 208-965-8118
  • Fax: 208-965-8128
Mailing address:
  • Phone: 208-965-8118
  • Fax: 208-965-8128

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 Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY SORIN ISPIRESCU
Title or Position: OWNER
Credential: MD
Phone: 208-965-8118