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Organization
IDAHO SURGICENTER NORTH LLC
Active
Organization
IDAHO SURGICENTER NORTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY D QUINTON DPM (OWNER)
(208) 529-0009
Entity
Organization
Contact information
Practice address
3369 MERLIN DR, IDAHO FALLS, ID 83404-7405
(208) 529-0009
(208) 529-2252
Mailing address
PO BOX 1386, IDAHO FALLS, ID 83403-1386
(208) 529-0009
(208) 529-2252
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
P 186
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010027109
BLUE SHIELD
HI
01
—
04085
BLUE CROSS
ID
Enumeration date
08/08/2006
Last updated
08/22/2020
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