1851799621 NPI number — ORTHOPEDIC SPECIALTY INSTITUTE, LLC

Table of content: (NPI 1851799621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851799621 NPI number — ORTHOPEDIC SPECIALTY INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC SPECIALTY INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851799621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1621 N 3RD ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-3384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-758-0716
Provider Business Mailing Address Fax Number:
208-667-7717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1621 N 3RD ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-3384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-758-0716
Provider Business Practice Location Address Fax Number:
208-667-7717
Provider Enumeration Date:
12/10/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ST MARK
Authorized Official First Name:
CAITLIN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
208-758-0486

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1851799621 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".