MEDICARE: LEWIS & CLARK ORTHOPAEDIC INSTITUTE LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611193000	OTHER	ID	OWCP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	04606	OTHER	ID	IBC
4	0198920	OTHER	ID	WLI
5	7124381	OTHER	ID	WWL
6	3570555	OTHER	ID	TRICARE
7	000010146573	OTHER	ID	RBS

NPI Number	:	1922093293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS & CLARK ORTHOPAEDIC INSTITUTE LLC

Provider Business Mailing Address
First Line	:	318 WARNER DR
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-4441
Country	:	US
Telephone Number	:	208-298-1050
Fax Number	:	208-298-1060

Provider Business Practice Location Address
First Line	:	318 WARNER DR
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501-4441
Country	:	US
Telephone Number	:	208-298-1050
Fax Number	:	208-298-1060

Authorized Official
Title or Position	:	VP OPERATIONS
Name	:	JEANNE DESAUTELS
Credential	:
Telephone Number	:	303-881-7687

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	12/17/2025

336 WARNER DR STE 4
LEWISTON, ID
83501-4441

Practice Phone: 208-413-3835
Practice Fax: 208-795-8553

320 WARNER DR
LEWISTON, ID
83501-4441