| NPI | 1114912102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA PAHSSEN Credentialing Manager 208-489-1431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID 1870273) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-12-08 |