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General NPI Number Information
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NPI Number | 1831134584
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Entity Type | Organization
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Legal Business Name | REXBURG SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 381 EAST 4TH NORTH SUITE 200
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-359-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 381 EAST 4TH NORTH SUITE 200
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-359-2300
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Fax |
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Authorized Official
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Title or Position | BOARD CHAIRMAN
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Name | DR. DWAYNE M HANSEN
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Credential | M.D.
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Telephone | 208-359-2300
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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 | ID
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