Organization
MOUNTAIN WEST SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BRADLEY MD (OWNER)
(208) 992-5212
Entity
Organization
Contact information
Practice address
2960 E ST LUKES ST, SUITE 200, MERIDIAN, ID 83642-3506
(208) 992-5212
Mailing address
2960 E ST LUKES ST, SUITE 200, MERIDIAN, ID 83642
(208) 992-5212
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
03/12/2024
Last updated
12/04/2025
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