Healthcare Provider Details

I. General information

NPI: 1669720397
Provider Name (Legal Business Name): PLEASANT VIEW SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 WEST EXPO PARKWAY
POST FALLS ID
83854
US

IV. Provider business mailing address

4171 WEST EXPO PARKWAY
POST FALLS ID
83854
US

V. Phone/Fax

Practice location:
  • Phone: 208-262-3823
  • Fax:
Mailing address:
  • Phone: 208-582-3793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberW-113717
License Number StateID

VIII. Authorized Official

Name: DR. JEFFREY LYMAN
Title or Position: CEO
Credential: MD
Phone: 480-203-0425