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General NPI Number Information
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NPI Number | 1174005235
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Entity Type | Organization
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Legal Business Name | IDAHO FALLS ASC
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 3302 VALENCIA DRIVE SUITE 101A
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-557-4525
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Fax | 208-542-4280
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Provider Business Mailing Address
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Address Line | 3302 VALENCIA DR STE 101A
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7068
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Country | US
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Telephone | 208-557-4525
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Fax | 208-542-4280
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Authorized Official
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Title or Position | CCO
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Name | NED W HILLYARD
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Credential |
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Telephone | 208-557-2711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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