Provider Demographics
NPI:1093472748
Name:DEWING SPORTS ORTHOPEDIC SURGERY PLLC
Entity Type:Organization
Organization Name:DEWING SPORTS ORTHOPEDIC SURGERY PLLC
Other - Org Name:DEWING SPORTS ORTHOPEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BATEMAN
Authorized Official - Last Name:DEWING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-618-6070
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1479
Mailing Address - Country:US
Mailing Address - Phone:208-618-6070
Mailing Address - Fax:208-618-8903
Practice Address - Street 1:1610 E SCHNEIDMILLER AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7065
Practice Address - Country:US
Practice Address - Phone:208-618-6070
Practice Address - Fax:208-618-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty