| NPI | 1205931615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH REED LIVINGSTON Administrator 208-367-7160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M7088) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M7089) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2008-02-21 |