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Organization

LEWISTON ORTHOPAEDIC ASSOCIATES PA

Active
Other names
Lewiston Orthopaedic Associates PA
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CINDY L KEENE (CEO)
(208) 298-1020
Entity
Organization

Contact information

Practice address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 743-3523
(208) 746-8741
Mailing address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 743-3523
(208) 746-8741

Taxonomy

Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
261QM1300X
Multi-Specialty Clinic/Center
BL04-213478
ID
261QM2500X
Medical Specialty Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010026897
REGENCE BLUESHIELD IDAHO
ID
05
002397200
ID
05
7849003
WA
01
89409
BCI
ID
Enumeration date
12/04/2006
Last updated
01/24/2017
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