Provider Demographics
NPI:1861589236
Name:SANDPOINT ORTHOPEDICS, PC
Entity type:Organization
Organization Name:SANDPOINT ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-8597
Mailing Address - Street 1:606 N 3RD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1689
Mailing Address - Country:US
Mailing Address - Phone:208-263-8597
Mailing Address - Fax:208-265-0667
Practice Address - Street 1:606 N 3RD AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1689
Practice Address - Country:US
Practice Address - Phone:208-263-8597
Practice Address - Fax:208-265-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID360191400OtherUS DEPT OF LABOR
WA7134737Medicaid
ID8M799OtherBLUE CROSS
ID808300500Medicaid
MT1861589236Medicaid
ID1009215OtherIDAHO STATE INSURANCE
ID000010149140OtherREGENCE BLUE SHIELD
IDDE2554OtherRAILROAD MEDICARE
ID4837030001Medicare NSC
IDDE2554OtherRAILROAD MEDICARE
WA7134737Medicaid