Healthcare Provider Details

I. General information

NPI: 1356265383
Provider Name (Legal Business Name): NORTH IDAHO DAY SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 E SUPER 1 LOOP STE A
ATHOL ID
83801-7109
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 208-561-9970
  • Fax: 208-561-9997
Mailing address:
  • Phone: 208-262-2498
  • Fax: 208-262-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON BELL
Title or Position: PAYOR ENROLLMENT SPECIALIST
Credential:
Phone: 208-618-2559