MEDICARE: IDAHO FALLS SURGICAL CENTER

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	367500000X	Certified Registered Nurse Anesthetist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB0412	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952568099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDAHO FALLS SURGICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 52180
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83405-2180
Country	:	US
Telephone Number	:	208-529-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 E 17TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6429
Country	:	US
Telephone Number	:	208-529-1945
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK L. PETERSEN
Credential	:	MD
Telephone Number	:	208-529-1945

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1073448478 — SYDNEY JUNE DUSTIN MDA, RDN, LD
Practice Location Address:

1957 E 17TH ST
IDAHO FALLS, ID
83404-6429

Practice Phone: 208-523-1100
Practice Fax:

1295544344 — JACESON BANHAM PA-C
Practice Location Address:

1957 E 17TH ST
IDAHO FALLS, ID
83404-6429

Practice Phone: 208-523-1100
Practice Fax:

1003994237 — IDAHO FALLS SURGICAL CENTER
Practice Location Address:

1945 E 17TH ST
IDAHO FALLS, ID
83404-6429

Practice Phone: 208-529-1945
Practice Fax:

1386722429 — JON F CHAMPLIN CRNA
Practice Location Address:

1945 E 17TH ST
IDAHO FALLS, ID
83404-6429

Practice Phone: 208-529-1945
Practice Fax:

1053481218 — IDAHO FALLS SURCIGAL CENTER
Practice Location Address:

1945 E 17TH ST
IDAHO FALLS, ID
83404-6429

Practice Phone: 208-529-1945
Practice Fax: 208-529-1961

1659426617 — TETON CANCER INSTITUTE
Practice Location Address:

1957 E 17TH ST
IDAHO FALLS, ID
83404-6429

Practice Phone: 208-523-1100
Practice Fax: 208-557-2701

Directions to “IDAHO FALLS SURGICAL CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.