1. Home
  2. Directory
  3. Idaho
  4. Meridian
  5. Orthopaedic Surgery
  6. NPI Profile

SPINE INSTITUTE OF IDAHO P A
NPI 1659380269
Orthopaedic Surgery - Orthopaedic Surgery of the Spine in Meridian, ID

Active since August 05, 2006CLIA 13D2099311 · Waiver
360 E MONTVUE DR, SUITE 100, MERIDIAN, ID 83642(208) 855-2900(208) 898-9877 Get Directions Write a Review

NPPES record last updated: October 4, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Spine Institute Of Idaho P A NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPINE INSTITUTE OF IDAHO P A (NPI 1659380269) is a healthcare organization registered as an orthopaedic surgery of the spine in Meridian, Idaho and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through July 23, 2027 and lists Tyler Cooper, Office Asst Administrator, as its authorized official.

NPPES Registry Identity

NPI1659380269
Entity TypeOrganization
Primary Taxonomy207XS0117X
Legal Business NameSPINE INSTITUTE OF IDAHO P A
Location Address360 E MONTVUE DR, SUITE 100Meridian, ID 83642-6318
Mailing Address360 E Montvue Dr, Suite 100Meridian, ID 83642-6318 · (208) 855-2900 · Fax (208) 898-9877
Phone(208) 855-2900
Fax(208) 898-9877
Organization SubpartNo
Authorized OfficialTyler CooperOffice Asst Administrator · (208) 855-2900
Enumeration DateAugust 5, 2006
Last NPPES UpdateOctober 4, 2016
✔ NPI 1659380269 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Orthopaedic Surgery of the SpineAllopathic & Osteopathic Physicians
Taxonomy Code207XS0117X
Definition
Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive.
360 E MONTVUE DR, Meridian, ID 83642
Open in Google Maps ↗

Other Identifiers 5

Medicaid805983000ID
Medicare PINCJ6135ID
Medicare PIN1377628ID
Medicare NSC5045100001ID
Medicare PINDC2869ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2099311

Spine Institute Of Idaho · Meridian, ID
Active · expires Jul 23, 2027
CLIA Number13D2099311
Laboratory TypePhysician Office
Certificate Effective DateJuly 24, 2025
Certificate Expiration DateJuly 23, 2027
Laboratory DirectorSamuel Jorgensen
Laboratory Phone(208) 855-2900
Laboratory LocationSpine Institute Of Idaho360 E Montvue Dr #100, Meridian, ID 83642
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SARI BIANCA LAVARIAS PA-C
Plastic Surgery
360 E MONTVUE DR
MERIDIAN, ID 83642
Ada County (208) 855-2900
MRS. KELLI ELIZABETH DEBOOY PHYSICAL THERAPIST
Physical Therapist
360 E MONTVUE DR, SUITE 100
MERIDIAN, ID 83642
Ada County (208) 855-2900
DR. MICHAEL BRYON SPACKMAN MD
Physical Medicine & Rehabilitation (Pain Medicine)
360 E MONTVUE DR, SUITE 100
MERIDIAN, ID 83642
Ada County (208) 855-2900
SAMUEL STEVEN JORGENSON M.D.
Orthopaedic Surgery (Orthopaedic Surgery of the Spine)
360 E MONTVUE DR, SUITE 100
MERIDIAN, ID 83642
Ada County (208) 855-2900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Spine Institute Of Idaho P A's NPI number?

The NPI number for Spine Institute Of Idaho P A is 1659380269. It was assigned to this organization in the NPPES registry on August 5, 2006.

Where is Spine Institute Of Idaho P A located?

Spine Institute Of Idaho P A is located at 360 E Montvue Dr Suite 100, Meridian, ID 83642. The listed phone number is (208) 855-2900.

What is Spine Institute Of Idaho P A's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Orthopaedic Surgery of the Spine, with taxonomy code 207XS0117X.

Does Spine Institute Of Idaho P A hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2099311) is associated with this NPI, valid through July 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Spine Institute Of Idaho P A was last updated on October 4, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.