IDAHO SURGICENTER INC NPI 1992759930

NPI Information

NPI: 1992759930
Provider Name: IDAHO SURGICENTER INC

Doing Business As: IDAHO SURGICENTER SOUTH

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

Specialization: Ambulatory Surgical

Address:
1157 CALL PLACE
POCATELLO, ID
ZIP 83201
Phone: (208) 238-6337
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IDAHO SURGICENTER INC is an ambulatory surgical clinic center in Pocatello, ID. IDAHO SURGICENTER INC NPI is 1992759930. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Idaho Surgicenter South.

The provider's business location address is:

1157 CALL PLACE
POCATELLO, ID
ZIP 83201
Phone: (208) 238-6337
Fax: (208) 776-5510

The provider's authorized official is Sean Barnard .
The authorized official title is Administrator and has the following contact phone number (208) 852-6242.

The CLIA number assigned to this NPI record is 13D0970668 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2006 and was last updated on 1/31/2022.

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	213ES0103X	Podiatrist	Foot & Ankle Surgery	P166	IDAHO	No
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	P92	IDAHO	No
3	213ES0103X	Podiatrist	Foot & Ankle Surgery	P153	IDAHO	No
4	332B00000X	Durable Medical Equipment & Medical Supplies				No
5	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03913	OTHER	IDAHO	BLUE CROSS
2	805730900	MEDICAID	IDAHO
3	P00091636	OTHER	IDAHO	RAILROAD MEDICARE
4	000010027108	OTHER	IDAHO	BLUE SHIELD
5	807288200	MEDICAID	IDAHO

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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