Mini-Cassia Surgical PC

NPI #1457656217 in Rupert, Idaho

Provider Information

NPI Number: 1457656217
Entity Type: Organization
Organization Name: Mini-Cassia Surgical PC
Primary Specialty: Surgery
Enumeration Date: Jan 25, 2011
Last Updated: Jan 25, 2011

Practice Location

Address: 1218 9TH ST
Address 2: STE 10
City: Rupert
State: Idaho
ZIP Code: 83350-2207
Phone: (208) 436-8340

Authorized Official

Name: DR. DACLYNN SCOTT JOHNSON, M.D.
Title: PRESIDENT
Phone: (208) 436-8340

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Surgery	208600000X	Primary

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