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General NPI Number Information
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NPI Number | 1669720397
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Entity Type | Organization
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Legal Business Name | PLEASANT VIEW SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 4171 WEST EXPO PARKWAY
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City | POST FALLS
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-262-3823
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Fax |
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Provider Business Mailing Address
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Address Line | 4171 WEST EXPO PARKWAY
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City | POST FALLS
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-582-3793
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JEFFREY LYMAN
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Credential | MD
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Telephone | 480-203-0425
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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 | W-113717
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License Number State | ID
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