Interventional Pain Consultants PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

INTERVENTIONAL PAIN CONSULTANTS PA

Practice address

2841 Juniper Dr
Lewiston, ID 83501-4719

Phone

(208) 743-9712

Fax

(208) 748-4312

NPI assigned

Nov 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Thomas Grissom, MD

Title

Owner/Director

Phone

(208) 743-9712

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196121600000",
    "number": "1457533937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 JUNIPER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014719",
            "telephone_number": "208-743-9712",
            "fax_number": "208-748-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2841 JUNIPER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014719",
            "telephone_number": "208-743-9712",
            "fax_number": "208-748-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN CONSULTANTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2007-11-27",
        "status": "A",
        "authorized_official_last_name": "GRISSOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "208-743-9712",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ifiok Akpan Idem, MD
• Institute of Physical Therapy and Fitness
• Integrative Medicine of Lewiston
• Intermountain Anesthesia Associates PLLC
• Interventional Pain Consultants PA
• Interventional Pain Consultants PA
• Ipc Surgical Center LLC
• Amy Rachel Irby, LMT
• Waycee Jae Irish
• Rowena Kathryn Jackson, LCPC

• All providers in Lewiston, ID
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.