Maxwell, Shane A

Maxwell, Shane A is an individual health care provider with primary practice located at 3551 E Overland Rd , Meridian ID 83642-6757. He recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Pain Medicine, which is considered as his primary health care specialty. Maxwell, Shane A can be contacted via phone (208) 884-1333.

Contact Information

Primary practice address
3551 E Overland Rd Meridian ID 83642-6757
Phone: (208) 884-1333
Fax: (208) 489-5188
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X O0385 Idaho

Profile Details

NPI number 1508825456
LBN Legal business name Maxwell, Shane A
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2006
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508825456 NPPES
Idaho MEDICAID 807415700
Idaho MEDICAID 1508825456

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