Basic Information
| Provider Information | |||||||||
| NPI: | 1265903736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POOLE JOINT REPLACEMENT SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2965 E TARPON DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836429007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082879420 | ||||||||
| FaxNumber: | 2082879426 | ||||||||
| Practice Location | |||||||||
| Address1: | 2365 E GALA ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836424881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083915811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | POOLE | ||||||||
| AuthorizedOfficialFirstName: | COLIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD, OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2083915811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.