Provider Demographics
NPI:1851799621
Name:ORTHOPEDIC SPECIALTY INSTITUTE, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALTY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ST MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-758-0486
Mailing Address - Street 1:1621 N 3RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3384
Mailing Address - Country:US
Mailing Address - Phone:208-758-0716
Mailing Address - Fax:208-667-7717
Practice Address - Street 1:1621 N 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3384
Practice Address - Country:US
Practice Address - Phone:208-758-0716
Practice Address - Fax:208-667-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1851799621Medicaid