Provider Demographics
NPI:1578370441
Name:DEWING SPORTS ORTHOPEDIC SURGERY PC
Entity type:Organization
Organization Name:DEWING SPORTS ORTHOPEDIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BATEMAN
Authorized Official - Last Name:DEWING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-618-6070
Mailing Address - Street 1:1610 E SCHNEIDMILLER AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7065
Mailing Address - Country:US
Mailing Address - Phone:208-618-6070
Mailing Address - Fax:208-618-8903
Practice Address - Street 1:1610 E SCHNEIDMILLER AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7065
Practice Address - Country:US
Practice Address - Phone:208-618-6070
Practice Address - Fax:208-618-8903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEWING SPORTS ORTHOPEDIC SURGERY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies