Provider Demographics
NPI:1306291836
Name:IDAHO SPINE & PAIN PLLC
Entity type:Organization
Organization Name:IDAHO SPINE & PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZARSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-672-4640
Mailing Address - Street 1:1859 S TOPAZ WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4401
Mailing Address - Country:US
Mailing Address - Phone:208-672-4640
Mailing Address - Fax:208-957-6300
Practice Address - Street 1:1859 S TOPAZ WAY STE 106
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4401
Practice Address - Country:US
Practice Address - Phone:208-672-4640
Practice Address - Fax:208-957-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM13074207L00000X
207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01568801OtherRAILROAD MEDICARE
TX329858YP64OtherMEDICARE TX
IDM13074OtherIDAHO STATE BOARD OF MEDICINE