| NPI | 1164611430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB ERICKSON CEO 208-785-3801 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207N00000X Dermatology | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2019-12-16 |