Healthcare Provider Details

I. General information

NPI: 1780515189
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF AMERICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 E TERRY ST
POCATELLO ID
83201-2733
US

IV. Provider business mailing address

1515 E CLARK ST
POCATELLO ID
83201-4133
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-2273
  • Fax:
Mailing address:
  • Phone: 208-233-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LANCE LONGMORE
Title or Position: OWNER
Credential: DO
Phone: 208-233-2273