EXODUS PAIN CLINIC (NPI# 1366849572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366849572 |
| Entity Type | Organization |
| Organization Name | EXODUS PAIN CLINIC |
| Practice Address |
3875 E Overland Rd Suite 200 Meridian ID 83642-9005 |
| Practice Telephone | 2089477246 |
| Practice Fax Number | 2082977772 |
| Mailing Telephone | 2089477246 |
| Mailing Fax Number | 2082977772 |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2016-04-13 |
| Authorized Official Name | DANIEL MARSH (MD/OWNER) |
| Authorized Official Telephone | 2089942907 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
M9452 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1356377535 | 05 |
| Street Address |
3875 E OVERLAND RD SUITE 200 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-9005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568443158 | Paul Calvin Collins | Orthopaedic Surgery | 3875 E Overland Rd, Meridian, ID 83642-9005 | 2005-11-10 |
| 1417335860 | St Alphonsus Regional Medical Center Inc | Clinic/Center | 3875 E Overland Rd, Meridian, ID 83642 | 2015-05-18 |
| 1891048773 | Amy Kathryn Thompson | Physical Therapist | 3875 E Overland Rd, Meridian, ID 83642-9005 | 2012-10-17 |
| 1508187428 | Kristi J. Mcmahan | Physical Therapist | 3875 E Overland Rd, Meridian, ID 83642-9005 | 2010-06-15 |
| 1316128036 | Sage Diagnostics & Imaging | Clinic/Center | 3875 E Overland Rd, Meridian, ID 83642-9005 | 2007-11-21 |
| 1275721912 | Les Bois Neurology Chartered | Specialist | 3875 E Overland Rd, Meridian, ID 83642-9005 | 2007-10-09 |
| 1396945069 | James H Morland, Md | Physical Medicine & Rehabilitation | 3875 E Overland Rd, Suite 200, Meridian, ID 83642-9005 | 2007-07-20 |
| 1922201615 | Heidi T Orme | Psychiatry & Neurology | 3875 E Overland Rd, Meridian, ID 83642-9005 | 2007-06-08 |
| 1235166885 | James Michael Herrold | Psychiatry & Neurology | 3875 E Overland Rd, Suite 201, Meridian, ID 83642-9005 | 2006-06-27 |
| 1215975164 | James H Morland | Physical Medicine & Rehabilitation | 3875 E Overland Rd, Suite 200, Meridian, ID 83642-9005 | 2006-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508825456 | Shane A Maxwell | Pain Medicine | 3551 E Overland Rd, Meridian, ID 83642-6757 | 2006-03-20 |
| 1922092881 | Eric Pearson | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2005-09-07 |
| 1134596760 | Pain Partners, LLC | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2015-08-31 |
| 1043204654 | Kenneth Staggs Jr. | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2005-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588832992 | Idaho Pain Medicine, LLP | Pain Medicine | 8950 W Emerald St Ste 168, Boise, ID 83704-8296 | 2008-02-19 |
| 1427273853 | Kimberly A Vorse Md PC | Pain Medicine | 380 Washington Ave Suite 201, Ketchum, ID 83340 | 2007-04-13 |
| 1760403893 | Craig G Flinders | Pain Medicine | 2841 Juniper Dr, Lewiston, ID 83501-4719 | 2006-07-22 |
| 1740238849 | Patrick Edward Farrell | Pain Medicine | 301 W Myrtle St, Boise, ID 83702-7656 | 2006-05-04 |
| 1013556596 | Gritman Medical Center Inc | Pain Medicine | 804 S Washington St Ste A, Moscow, ID 83843-3182 | 2019-12-31 |
| 1639657521 | Heather Mckenzie | Pain Medicine | 2177 W Ironwood Center Dr, Coeur D Alene, ID 83814 | 2018-08-01 |
| 1336519891 | Timothy E. Snell, Md, Pllc | Pain Medicine | 2240 E Center St, Pocatello, ID 83201-2600 | 2015-09-28 |
| 1477941672 | Beacon Pain Clinic | Pain Medicine | 115 W Main St, 102, Boise, ID 83702-7302 | 2014-12-23 |
| 1609191881 | Christian Becker | Pain Medicine | 2060 S Woodruff Ave, Idaho Falls, ID 83404-6396 | 2010-03-31 |
| 1043445513 | Ryan D. Hope, M.d., LLC | Pain Medicine | 285 Vista Dr, Pocatello, ID 83201-4987 | 2009-05-27 |
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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.