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General NPI Number Information
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NPI Number | 1609825298
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF IDAHO LLC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 2855 E MAGIC VIEW DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6245
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Country | US
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Telephone | 208-639-4900
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Fax | 208-639-4919
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Provider Business Mailing Address
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Address Line | 2855 E MAGIC VIEW DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6245
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Country | US
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Telephone | 208-639-4900
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Fax | 208-639-4919
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD MICHAEL WALDMANN
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Credential | M.D.
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Telephone | 208-639-4900
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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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