Provider Demographics
NPI:1063725083
Name:PAIN SPECIALISTS OF IDAHO
Entity type:Organization
Organization Name:PAIN SPECIALISTS OF IDAHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:POSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-522-7246
Mailing Address - Street 1:2375 E SUNNYSIDE RD
Mailing Address - Street 2:SUITE 'J'
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8280
Mailing Address - Country:US
Mailing Address - Phone:208-522-7246
Mailing Address - Fax:
Practice Address - Street 1:2375 E SUNNYSIDE RD
Practice Address - Street 2:SUITE 'J'
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8280
Practice Address - Country:US
Practice Address - Phone:208-522-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11061261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain