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Organization
SOUTHERN IDAHO PAIN INSTITUTE P.C.
Active
Organization
SOUTHERN IDAHO PAIN INSTITUTE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINTON L. DILLE M.D. (OWNER/ANESTHESIOLOGIST)
(208) 733-3181
Entity
Organization
Contact information
Practice address
236 MARTIN ST., TWIN FALLS, ID 83301
(208) 733-3181
(208) 733-3168
Mailing address
236 MARTIN ST., TWIN FALLS, ID 83301
(208) 733-3181
(208) 733-3168
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
M7113
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006663
REGENCE ASC #
ID
01
—
03384
BLUE CROSS ASC#
ID
05
—
804229000
—
ID
Enumeration date
09/26/2006
Last updated
02/26/2010
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