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Organization
SURGICARE CENTER OF IDAHO, LLC
Active
Organization
SURGICARE CENTER OF IDAHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS PENNOW MBA (DIRECTOR)
(208) 336-8700
Entity
Organization
Contact information
Practice address
360 E MALLARD DR, STE 125, BOISE, ID 83706-3941
(208) 336-8700
(208) 426-0902
Mailing address
360 E MALLARD DR, STE 125, BOISE, ID 83706-6644
(208) 336-8700
(208) 426-0902
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273390
—
ID
Enumeration date
06/22/2005
Last updated
10/10/2016
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