MEDICARE: NORTH IDAHO DAY SURGERY LLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1740917111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH IDAHO DAY SURGERY LLC

Provider Business Mailing Address
First Line	:	1593 E POLSTON AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5326
Country	:	US
Telephone Number	:	208-262-2498
Fax Number	:	208-262-7461

Provider Business Practice Location Address
First Line	:	2207 N MOLTER RD STE 101
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7570
Country	:	US
Telephone Number	:	509-324-1222
Fax Number	:	509-324-1223

Authorized Official
Title or Position	:	PAYOR ENROLLMENT SPECIALIST
Name	:	JASON BELL
Credential	:
Telephone Number	:	208-618-2559

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	03/05/2026

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