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General NPI Number Information
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NPI Number | 1114304250
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Entity Type | Organization
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Legal Business Name | KHM SURGICAL PARTNERSHIP
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 339 W IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686-2856
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Country | US
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Telephone | 208-505-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 339 W IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686-2856
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Country | US
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Telephone | 208-505-1946
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Fax |
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Authorized Official
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Title or Position | ACCESS MANAGER
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Name | KAYLYN GREEN
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Credential |
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Telephone | 208-505-1946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | D4557OS
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License Number State | ID
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