Provider Demographics
NPI:1144646126
Name:STEM CELL CENTERS OF IDAHO PC
Entity type:Organization
Organization Name:STEM CELL CENTERS OF IDAHO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-808-0708
Mailing Address - Street 1:223 W IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2651
Mailing Address - Country:US
Mailing Address - Phone:208-215-3261
Mailing Address - Fax:208-966-4284
Practice Address - Street 1:1341 N NORTHWOOD CENTER CT STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2471
Practice Address - Country:US
Practice Address - Phone:208-771-7054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty