Provider Demographics
NPI:1861615346
Name:NEUROSURGERY & SPINE CARE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:NEUROSURGERY & SPINE CARE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOLONIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-746-5025
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0974
Mailing Address - Country:US
Mailing Address - Phone:208-746-5025
Mailing Address - Fax:208-746-4946
Practice Address - Street 1:324 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2408
Practice Address - Country:US
Practice Address - Phone:208-746-5025
Practice Address - Fax:208-746-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117922Medicaid
ID806652800Medicaid
WA8143836Medicaid
ID002587000Medicaid
WA8143836Medicaid
IDP00052821Medicare PIN
WAGAB39182Medicare PIN
ID1126893Medicare PIN