Provider Demographics
NPI:1700974714
Name:INLAND NORTHWEST SPINE PLLC
Entity Type:Organization
Organization Name:INLAND NORTHWEST SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-667-1376
Mailing Address - Street 1:850 W IRONWOOD DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4903
Mailing Address - Country:US
Mailing Address - Phone:208-667-1376
Mailing Address - Fax:208-292-0873
Practice Address - Street 1:850 W IRONWOOD DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4903
Practice Address - Country:US
Practice Address - Phone:208-667-1376
Practice Address - Fax:208-292-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6482207T00000X
207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5975360001Medicare NSC
ID1369904Medicare PIN