MEDICARE: SOUTHEASTERN IDAHO SURGICAL ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1164372777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN IDAHO SURGICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	3695 STONEGATE DR
Second Line	:
City	:	AMMON
State	:	ID
Zip	:	83406-7532
Country	:	US
Telephone Number	:	208-525-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 VALENCIA DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7597
Country	:	US
Telephone Number	:	208-525-9400
Fax Number	:	208-525-6151

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRETT MCBRIDE
Credential	:	DO
Telephone Number	:	208-525-9400

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/09/2026

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