| NPI | 1700552213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J BROWN Owner/Provider 208-378-4264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2025-04-25 |