Healthcare Provider Details

I. General information

NPI: 1497745178
Provider Name (Legal Business Name): SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FALLS AVE W
TWIN FALLS ID
83301
US

IV. Provider business mailing address

115 FALLS AVE W
TWIN FALLS ID
83301
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-1662
  • Fax: 208-734-1023
Mailing address:
  • Phone: 208-733-1662
  • Fax: 208-734-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH A WENSINK
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-733-1662