Healthcare Provider Details

I. General information

NPI: 1003994237
Provider Name (Legal Business Name): IDAHO FALLS SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E 17TH ST
IDAHO FALLS ID
83404-6429
US

IV. Provider business mailing address

PO BOX 52180
IDAHO FALLS ID
83405-2180
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-1945
  • Fax:
Mailing address:
  • Phone: 208-523-4906
  • Fax: 208-523-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN V KLIPPERT
Title or Position: PRESIDENT
Credential: MD
Phone: 208-529-1945