Provider Demographics
NPI:1124060983
Name:VERST SPINE & ORTHOPEDIC CARE,PLLC
Entity type:Organization
Organization Name:VERST SPINE & ORTHOPEDIC CARE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-788-7779
Mailing Address - Street 1:15 WEST GALENA ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333
Mailing Address - Country:US
Mailing Address - Phone:208-788-7779
Mailing Address - Fax:208-788-7784
Practice Address - Street 1:15 WEST GALENA ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333
Practice Address - Country:US
Practice Address - Phone:208-788-7779
Practice Address - Fax:208-788-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8204207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806197100Medicaid
IDH24785Medicare UPIN
ID5843570001Medicare NSC