| NPI | 1760214654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PARKER R FILLMORE Director 208-572-2272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery |
| Additional Taxonomies | 208600000X Surgery |
| 2086S0102X Surgery Surgical Critical Care | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |