Healthcare Provider Details

I. General information

NPI: 1265816003
Provider Name (Legal Business Name): CLEARVIEW SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 JUNIPER DR
LEWISTON ID
83501-4719
US

IV. Provider business mailing address

2500 W A ST SUITE 202
MOSCOW ID
83843-6000
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRENDA HALEN
Title or Position: OFFICE MGR
Credential:
Phone: 208-882-4662