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REXBURG SURGERY CENTER LLC NPI 1831134584


NPI Information

NPI: 1831134584
Provider Name: REXBURG SURGERY CENTER LLC

Doing Business As: NORTH FORK SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
381 EAST 4TH NORTH
SUITE 200
REXBURG, ID
ZIP 83440
Phone: (208) 359-2300
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REXBURG SURGERY CENTER LLC is an ambulatory surgical clinic center in Rexburg, ID. REXBURG SURGERY CENTER LLC NPI is 1831134584. The provider is registered as an organization entity type.
The provider Is Doing Business As North Fork Surgery Center.

The provider's business location address is:

381 EAST 4TH NORTH
SUITE 200
REXBURG, ID
ZIP 83440
Phone: (208) 359-2300

The provider's authorized official is Dwayne M Hansen .
The authorized official title is Board Chairman and has the following contact phone number (208) 359-2300.

The enumeration date for this NPI number is 6/17/2006 and was last updated on 8/22/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QA1903XClinic/CenterAmbulatory SurgicalIDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
104870OTHERIDAHOBLUE CROSS PROVIDER NUMBE
280760000MEDICAIDIDAHO
3000010158869OTHERIDAHOBLUE SHIELD PROVIDER NUMB

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

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