MR. SHANE A MAXWELL (NPI# 1508825456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1508825456 |
Entity Type | Individual |
Full Name | MR. SHANE A MAXWELL |
Credential | D.O. |
Practice Address |
3551 E Overland Rd Meridian ID 83642-6757 |
Mailing Address |
Po Box 1128 Boise ID 83701-1128 |
Practice Telephone | 2088841333 |
Practice Fax Number | 2084895188 |
Mailing Telephone | (208) 381-2222 |
Mailing Fax Number | 2084633044 |
Enumeration Date | 2006-03-20 |
Last Update Date | 2017-08-11 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
O0385 | ID | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | 807415700 | 05 | |
ID | 1508825456 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689635740 | Shane R. Maxwell | Family Medicine | 3801 Scott and White Dr, Killeen, TX 76543-5252 | 2006-03-29 |
Street Address |
3551 E OVERLAND RD |
City | MERIDIAN |
State | ID |
Zip Code | 83642-6757 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912319740 | Garrett Weldon | Physical Therapist | 3551 E Overland Rd, Meridian, ID 83642-6757 | 2014-05-28 |
1770924532 | Scott A Stephens | Physical Therapist | 3551 E Overland Rd, Meridian, ID 83642-6757 | 2013-07-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
Find all providers in zip 83642 |
Taxonomy Code | 208VP0014X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pain Medicine |
Specialization | Interventional Pain Medicine |
Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922092881 | Eric Pearson | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2005-09-07 |
1134596760 | Pain Partners, LLC | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2015-08-31 |
1366849572 | Exodus Pain Clinic | Pain Medicine | 3875 E Overland Rd, Suite 200, Meridian, ID 83642-9005 | 2014-12-03 |
1043204654 | Kenneth Staggs Jr. | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2005-09-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588832992 | Idaho Pain Medicine, LLP | Pain Medicine | 8950 W Emerald St Ste 168, Boise, ID 83704-8296 | 2008-02-19 |
1427273853 | Kimberly A Vorse Md PC | Pain Medicine | 380 Washington Ave Suite 201, Ketchum, ID 83340 | 2007-04-13 |
1760403893 | Craig G Flinders | Pain Medicine | 2841 Juniper Dr, Lewiston, ID 83501-4719 | 2006-07-22 |
1740238849 | Patrick Edward Farrell | Pain Medicine | 301 W Myrtle St, Boise, ID 83702-7656 | 2006-05-04 |
1013556596 | Gritman Medical Center Inc | Pain Medicine | 804 S Washington St Ste A, Moscow, ID 83843-3182 | 2019-12-31 |
1639657521 | Heather Mckenzie | Pain Medicine | 2177 W Ironwood Center Dr, Coeur D Alene, ID 83814 | 2018-08-01 |
1336519891 | Timothy E. Snell, Md, Pllc | Pain Medicine | 2240 E Center St, Pocatello, ID 83201-2600 | 2015-09-28 |
1477941672 | Beacon Pain Clinic | Pain Medicine | 115 W Main St, 102, Boise, ID 83702-7302 | 2014-12-23 |
1609191881 | Christian Becker | Pain Medicine | 2060 S Woodruff Ave, Idaho Falls, ID 83404-6396 | 2010-03-31 |
1043445513 | Ryan D. Hope, M.d., LLC | Pain Medicine | 285 Vista Dr, Pocatello, ID 83201-4987 | 2009-05-27 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.