Organization
INTERVENTIONAL PAIN CONSULTANTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN THOMAS GRISSOM MD (OWNER/DIRECTOR)
(208) 743-9712
Entity
Organization
Contact information
Practice address
2841 JUNIPER DR, LEWISTON, ID 83501-4719
(208) 743-9712
(208) 748-4312
Mailing address
2841 JUNIPER DR, LEWISTON, ID 83501-4719
(208) 743-9712
(208) 748-4312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/27/2007
Last updated
11/27/2007
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