NPI | 1306629027 |
---|---|
Entity Type | Organization |
Authorized Contact | JASON BELL Payor Enrollment Specialist 208-262-2498 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
Enumeration Date | 2023-08-16 |
Last Update Date | 2024-04-17 |