Surgicare Center of Idaho, LLC

NPI #1114923471 in Boise, Idaho

Provider Information

NPI Number: 1114923471
Entity Type: Organization
Organization Name: Surgicare Center of Idaho, LLC
Primary Specialty: Clinic/Center - Ambulatory Surgical
Enumeration Date: Jun 22, 2005
Last Updated: Oct 10, 2016

Practice Location

Address: 360 E MALLARD DR
Address 2: STE 125
City: Boise
State: Idaho
ZIP Code: 83706-3941
Phone: (208) 336-8700

Authorized Official

Name: MR. LOUIS PENNOW, MBA
Title: DIRECTOR
Phone: (208) 336-8700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Ophthalmologic Surgery — Ophthalmologic Surgery	261QS0132X
Clinic/Center - Ambulatory Surgical — Ambulatory Surgical	261QA1903X	Primary

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