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Contact Information

EXODUS PAIN CLINIC
987 S ALLANTE PL
BOISE, ID83709-1612
 Phone: 208-947-7246
 Fax: 208-297-7772
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for EXODUS PAIN CLINIC · (Female)

NPI Number 1366849572
Status Active
Credentials
Entity Individual
Enumeration date 12/03/2014
Last updated 06/22/2023 - About 3 years ago
Sole proprietor 1 Not specified
Identifiers
  • ID License # M9452
  • ID Medicaid 1356377535
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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