Provider Demographics
NPI:1669785192
Name:WIND RIVER PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:WIND RIVER PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:KLIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-522-4598
Mailing Address - Street 1:1975 MARTHA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7580
Mailing Address - Country:US
Mailing Address - Phone:208-522-4598
Mailing Address - Fax:208-529-3915
Practice Address - Street 1:1975 MARTHA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7580
Practice Address - Country:US
Practice Address - Phone:208-522-4598
Practice Address - Fax:208-529-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty