Eastern Idaho Spine Center
LBN: Eastern Idaho Spine Center
Eastern Idaho Spine Center is an health care organization with primary practice located at 2860 Channing Way Ste 112, Idaho Falls ID 83404-7531. The organization recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner, which is considered as the primary health care specialty.
Eastern Idaho Spine Center can be contacted via phone (208) 535-4343, or through Mangrum, Shane Christian via phone (208) 535-4343.
Contact Information
Primary practice address
2860 Channing Way Ste 112
Idaho Falls ID 83404-7531
Phone: (208) 535-4343
Fax: (208) 535-4344
Website:
Authorized official contact:
Name: Mangrum, Shane Christian Doctor of Medicine (MD)
Phone: (208) 535-4343
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Rehabilitation Practitioner | 225400000X |
Profile Details
| NPI number | 1154593705 |
|---|---|
| LBN Legal business name | Eastern Idaho Spine Center |
| DBA Doing business as | |
| Authorized official | Mangrum, Shane Christian Doctor of Medicine (MD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 24th, 2008 |
| Last updated | Jun 6th, 2008 - about 17 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154593705 | NPPES |
| Idaho | MEDICAID | 8079840 |
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