# PAIN SPECIALISTS OF IDAHO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992070809
- **Authorized official:** CORI D ANDERSON (BILLING MANAGER)
- **Authorized official phone:** (208) 522-7246

## Contact information

- **Practice address:** 2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
- **Practice address phone:** (208) 522-7246
- **Practice address fax:** (208) 529-2620
- **Mailing address:** 2375 E SUNNYSIDE RD STE J, IDAHO FALLS, ID 83404-8281
- **Mailing address phone:** (208) 522-7246
- **Mailing address fax:** (208) 529-2620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | SPHY11061 | ID | Yes |

## Other

- **Enumeration date:** 03/12/2012
- **Last updated:** 03/12/2012