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Contact Information

SHANE A MAXWELL, DO
3551 E OVERLAND RD
MERIDIAN, ID83642-6757
 Phone: 208-884-1333
 Fax: 208-489-5188
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for SHANE A MAXWELL · (Male)

NPI Number 1508825456
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 03/20/2006
Last updated 07/21/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • ID License # O0385
  • ID Medicaid 1508825456
  • ID Medicaid 807415700
Hospital affiliation(s)
  • ST LUKES REGIONAL MEDICAL CENTER - (Acute Care)
    190 EAST BANNOCK STREET
    BOISE, ID 83712
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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