MEDICARE: JOHN ADAM JELINEK MD

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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	M-10275	ID
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	MD 60001068	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	238312	OTHER	WA	WA DEPT OF LABOR & INDUSTRIES
2	77378	OTHER	ID	BLUE CROSS OF ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568410025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ADAM JELINEK MD

Provider Business Mailing Address
First Line	:	320 WARNER DR
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-4441
Country	:	US
Telephone Number	:	208-743-3523
Fax Number	:	208-746-8741

Provider Business Practice Location Address
First Line	:	320 WARNER DR
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-4441
Country	:	US
Telephone Number	:	208-743-3523
Fax Number	:	208-746-8741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/24/2016

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Directions to “ JOHN ADAM JELINEK MD” Practice Location

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