Idaho Neurosurgery & Spine PLLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

IDAHO NEUROSURGERY & SPINE PLLC

Practice address

3345 Potomac Way
Idaho Falls, ID 83404

Phone

(208) 552-6210

Fax

(208) 552-2027

NPI assigned

Nov 11, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Clark H Allen, M.D.

Title

Owner

Phone

(208) 552-6210

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1415664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532476800000",
    "number": "1750787297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-552-6210",
            "fax_number": "208-552-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-552-6210",
            "fax_number": "208-552-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO NEUROSURGERY & SPINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-11",
        "last_updated": "2018-07-25",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-552-6210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Idaho Foot Surgery Center PC
• Idaho Heart Institute PC
• Idaho Heart Physician Group PLLC
• Idaho Holistic Therapy Group
• Idaho Home Health & Hospice, Inc.
• Idaho Neurosurgical Center, PA
• Idaho Physician Services Inc.
• Idaho Prosthetics & Orthotics, Inc.
• Idaho Psychiatric Institute
• Idaho Recovery Center, LLC.

• Neurological Surgery Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Neurological Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; 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.