SPINE CIN OF BOISE, LLC (NPI# 1104489376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104489376 |
| Entity Type | Organization |
| Organization Name | SPINE CIN OF BOISE, LLC |
| Practice Address |
800 W Main St Ste 1460-10 Boise ID 83702-5945 |
| Mailing Address |
102 Woodmont Blvd Ste 350 Nashville TN 37205-2216 |
| Practice Telephone | 6153860064 |
| Mailing Telephone | 6157332064 |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-04-15 |
| Authorized Official Name | EDWARD LELAND HUTTON EADIE (DIRECTOR) |
| Authorized Official Telephone | 6157332064 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0117X |
Orthopaedic Surgery Specialization: Orthopaedic Surgery of the Spine |
Allopathic & Osteopathic Physicians |
| Street Address |
800 W MAIN ST STE 1460-10 |
| City | BOISE |
| State | ID |
| Zip Code | 83702-5945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730688748 | Cardiac Cin of Boise LLC | Internal Medicine | 800 W Main St Ste 1460-10, Boise, ID 83702-5945 | 2018-02-05 |
| 1588227755 | Joint Replacement Cin of Boise, LLC | Orthopaedic Surgery | 800 W Main St Ste 1460-10, Boise, ID 83702-5945 | 2019-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 207XS0117X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Orthopaedic Surgery of the Spine |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083998827 | Boise Spine Surgery P.a. | Orthopaedic Surgery | 8756 W. Emerald Street, Suite 176, Boise, ID 83704-4834 | 2011-09-28 |
| 1699710541 | Joseph M Verska | Orthopaedic Surgery | 8756 W. Emerald St., Suite 176, Boise, ID 83704-4834 | 2006-06-17 |
| 1023029840 | Howard A King | Orthopaedic Surgery | 600 N Robbins Rd, Ste 100, Boise, ID 83702-4566 | 2006-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316029176 | Lynn J Stromberg | Orthopaedic Surgery | 2355 Coronado, Idaho Falls, ID 83404 | 2006-10-20 |
| 1396827150 | Mark A Weight | Orthopaedic Surgery | 2355 Coronado St, Idaho Falls, ID 83404-7407 | 2006-10-20 |
| 1124060983 | Verst Spine & Orthopedic Care,pllc | Orthopaedic Surgery | 15 West Galena St, Hailey, ID 83333 | 2006-06-12 |
| 1306831698 | Gregory Dean Dietrich | Orthopaedic Surgery | 320 Warner Drive, Lewiston, ID 83501 | 2005-09-13 |
| 1871850727 | Daniel John Blizzard | Orthopaedic Surgery | 1641 E Polston Ave Ste 101, Post Falls, ID 83854-7852 | 2012-04-17 |
| 1659380269 | Spine Institute of Idaho P A | Orthopaedic Surgery | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2006-08-05 |
| 1962447169 | Samuel Steven Jorgenson | Orthopaedic Surgery | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2006-06-19 |
| 1922041961 | David M. Christensen | Orthopaedic Surgery | 1411 Falls Ave E, Suite 1301, Twin Falls, ID 83301-3455 | 2006-06-14 |
| 1164465977 | David Bernard Verst | Orthopaedic Surgery | 15 West Galena St, Hailey, ID 83333 | 2006-06-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.