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NPI Code Detail

MEDICARE: IDAHO SPINE & PAIN PLLC

MEDICARE: IDAHO SPINE & PAIN PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianM13074ID
2207LP2900XPain Medicine (Anesthesiology) Physician
3208VP0014XInterventional Pain Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01568801OTHERTXRAILROAD MEDICARE
2329858YP64OTHERTXMEDICARE TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3M13074OTHERIDIDAHO STATE BOARD OF MEDICINE

General Provider Information

NPI Number : 1306291836
Entity Type Code : Organization
Provider Name (Legal Business Name) : IDAHO SPINE & PAIN PLLC
Provider Business Mailing Address
First Line : 1859 S TOPAZ WAY STE 106
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-4401
Country : US
Telephone Number : 208-672-4640
Fax Number : 208-957-6300
Provider Business Practice Location Address
First Line : 1859 S TOPAZ WAY STE 106
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-4401
Country : US
Telephone Number : 208-672-4640
Fax Number : 208-957-6300
Authorized Official
Title or Position : OWNER
Name : KARL R ZARSE
Credential : M.D.
Telephone Number : 208-672-4640
Provider Enumeration Date : 05/03/2016
Last Update Date : 09/10/2024

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Directions to “IDAHO SPINE & PAIN PLLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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