Provider Demographics
NPI:1902366834
Name:PAIN & SPINE CONSULTANTS
Entity Type:Organization
Organization Name:PAIN & SPINE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:POSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-677-8888
Mailing Address - Street 1:1344 HILAND AVENUE, STE A
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318
Mailing Address - Country:US
Mailing Address - Phone:208-677-8888
Mailing Address - Fax:208-678-5833
Practice Address - Street 1:1344 HILAND AVENUE, STE A
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-677-8888
Practice Address - Fax:208-678-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty