Healthcare Provider Details

I. General information

NPI: 1700552213
Provider Name (Legal Business Name): EVEREST SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 04/25/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 E ST LUKES ST
MERIDIAN ID
83642
US

IV. Provider business mailing address

2960 EAST ST LUKE S STREET
MERIDIAN ID
83642-9005
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-4264
  • Fax:
Mailing address:
  • Phone: 208-378-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID J BROWN
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 208-378-4264