Healthcare Provider Details

I. General information

NPI: 1609983089
Provider Name (Legal Business Name): INTERMOUNTAIN SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N ROBBINS RD STE 401
BOISE ID
83702
US

IV. Provider business mailing address

600 ROBBINS RD STE 401
BOISE ID
83702-4539
US

V. Phone/Fax

Practice location:
  • Phone: 208-383-0201
  • Fax: 208-489-4010
Mailing address:
  • Phone: 208-383-0201
  • Fax: 208-489-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDI BARNHART
Title or Position: BILLING COORDINATOR
Credential:
Phone: 208-489-4206