Eastern Idaho Spine Center
NPI 1154593705ActiveOrganization· Rehabilitation Practitioner· Idaho Falls, ID
Rehabilitation Practitioner in Idaho Falls, Idaho, registered in NPPES in March 2008. The authorized official on file is Shane Christian Mangrum, M.D., Owner.
Overview
| NPI | 1154593705 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 24, 2008 |
| Last updated in NPPES | Jun 6, 2008 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Rehabilitation Practitioner Primary | 225400000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Rehabilitation Practitioner providers in Idaho Falls
- 1225180110
- 1992227367
- 1447343462