Provider Demographics
NPI:1164170486
Name:SPEAR TMS
Entity Type:Organization
Organization Name:SPEAR TMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:208-619-9270
Mailing Address - Street 1:9321 N GOVERNMENT WAY STE E
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8263
Mailing Address - Country:US
Mailing Address - Phone:208-502-2744
Mailing Address - Fax:208-635-0135
Practice Address - Street 1:9321 N GOVERNMENT WAY STE E
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8263
Practice Address - Country:US
Practice Address - Phone:208-502-2744
Practice Address - Fax:208-635-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841618501Medicaid
PA1598779746Medicaid