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General NPI Number Information
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NPI Number | 1306291836
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Entity Type | Organization
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Legal Business Name | IDAHO SPINE & PAIN PLLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 1859 S TOPAZ WAY STE 106
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City | MERIDIAN
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State | ID
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Zip | 83642-4401
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Country | US
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Telephone | 208-672-4640
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Fax | 208-957-6300
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Provider Business Mailing Address
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Address Line | 1859 S TOPAZ WAY STE 106
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City | MERIDIAN
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State | ID
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Zip | 83642-4401
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Country | US
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Telephone | 208-672-4640
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Fax | 208-957-6300
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Authorized Official
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Title or Position | OWNER
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Name | KARL R ZARSE
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Credential | M.D.
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Telephone | 208-672-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | M13074
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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