Provider Demographics
NPI:1619539897
Name:NORTHWEST OCCUPATIONAL MEDICINE & NEUROSURGICAL SPINE INSTITUTE LLC
Entity type:Organization
Organization Name:NORTHWEST OCCUPATIONAL MEDICINE & NEUROSURGICAL SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MONTALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-327-5600
Mailing Address - Street 1:6140 W CURTISIAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-327-5631
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:8921 W HACKAMORE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1673
Practice Address - Country:US
Practice Address - Phone:208-375-1105
Practice Address - Fax:208-377-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty