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General NPI Number Information
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NPI Number | 1306010046
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Entity Type | Organization
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Legal Business Name | PEINE OSTEOPATHIC MEDICINE PLLC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 450 W STATE ST SUITE 250
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City | EAGLE
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State | ID
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Zip | 83616-7057
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Country | US
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Telephone | 208-947-0925
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Fax | 208-947-0926
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Provider Business Mailing Address
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Address Line | 450 W STATE ST SUITE 250
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City | EAGLE
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State | ID
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Zip | 83616-7057
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Country | US
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Telephone | 208-947-0925
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Fax | 208-947-0926
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER C PEINE
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Credential | D,O,
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Telephone | 208-947-0925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-0366
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License Number State | ID
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