Healthcare Provider Details

I. General information

NPI: 1508702275
Provider Name (Legal Business Name): CLEARWATER ADVANCED SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 E IRON EAGLE DR
EAGLE ID
83616-6599
US

IV. Provider business mailing address

1281 E IRON EAGLE DR
EAGLE ID
83616-6599
US

V. Phone/Fax

Practice location:
  • Phone: 208-985-6179
  • Fax: 833-468-5265
Mailing address:
  • Phone: 208-900-8087
  • Fax: 833-468-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RASHNA GINWALLA
Title or Position: OWNER
Credential: MD
Phone: 208-900-8087