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Organization
ADVANCED PAIN MANAGEMENT PLLC
Active
Organization
ADVANCED PAIN MANAGEMENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DALE SEVERSON MD (MEMBER)
(208) 880-9464
Entity
Organization
Contact information
Practice address
2275 SO EAGLE RD, SUTE 160, MERIDIAN, ID 83642
(208) 947-2266
(208) 947-2267
Mailing address
6140 CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 327-5600
(208) 367-2968
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
11/11/2008
Last updated
11/23/2011
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