Interventional Pain Consultants PA

NPI #1457533937 in Lewiston, Idaho

Provider Information

NPI Number: 1457533937
Entity Type: Organization
Organization Name: Interventional Pain Consultants PA
Primary Specialty: Physician Assistant
Enumeration Date: Nov 27, 2007
Last Updated: Nov 27, 2007

Practice Location

Address: 2841 JUNIPER DR
City: Lewiston
State: Idaho
ZIP Code: 83501-4719
Phone: (208) 743-9712

Authorized Official

Name: JOHN THOMAS GRISSOM, MD
Title: OWNER/DIRECTOR
Phone: (208) 743-9712

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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