| 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 |