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General NPI Number Information
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NPI Number | 1821276353
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Entity Type | Organization
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Legal Business Name | PEND OREILLE SURGERY CENTER LLC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 30544 HIGHWAY 200 SUITE 201
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City | PONDERAY
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State | ID
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Zip | 83852-5005
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Country | US
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Telephone | 208-265-8194
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Fax | 208-265-4870
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Provider Business Mailing Address
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Address Line | 30544 HIGHWAY 200 SUITE 201
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City | PONDERAY
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State | ID
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Zip | 83852-5005
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Country | US
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Telephone | 208-265-8194
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Fax | 208-265-4870
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KRISTI SABO
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Credential | RN
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Telephone | 208-265-8194
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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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