MEADOW LAKE SURGERY CENTER INC NPI 1740479476

NPI Information

NPI: 1740479476
Provider Name: MEADOW LAKE SURGERY CENTER INC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 13D2017234

Address:
3630 E LOUISE DR
SUITE 200
MERIDIAN, ID
ZIP 83642
Phone: (208) 377-9515
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MEADOW LAKE SURGERY CENTER INC is an ambulatory surgical clinic center in Meridian, ID. MEADOW LAKE SURGERY CENTER INC NPI is 1740479476. The provider is registered as an organization entity type.

The provider's business location address is:

3630 E LOUISE DR
SUITE 200
MERIDIAN, ID
ZIP 83642-975
Phone: (208) 377-9515
Fax: (208) 377-9517

The provider's authorized official is Mark D Wigod .
The authorized official title is M.d. and has the following contact phone number (208) 377-9515.

The CLIA number assigned to this NPI record is 13D2017234 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/18/2007 and was last updated on 9/16/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	M8189	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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