1922093293 NPI number — LEWIS & CLARK ORTHOPAEDIC INSTITUTE LLC

Table of content: (NPI 1922093293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922093293 NPI number — LEWIS & CLARK ORTHOPAEDIC INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS & CLARK ORTHOPAEDIC 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:
1922093293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 WARNER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-298-1050
Provider Business Mailing Address Fax Number:
208-298-1060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 WARNER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83501-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-298-1050
Provider Business Practice Location Address Fax Number:
208-298-1060
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KEENE
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
208-298-1020

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 611193000 . This is a "OWCP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 806919700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04606 . This is a "IBC" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0198920 . This is a "WLI" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 7124381 . This is a "WWL" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 3570555 . This is a "TRICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010146573 . This is a "RBS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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