# IDAHO SURGICAL ASSISTANTS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225389414
- **Authorized official:** REANNA PARK (BILLING SPECIALIST)
- **Authorized official phone:** (208) 525-2090

## Contact information

- **Practice address:** 190 E BANNOCK ST, BOISE, ID 83712-6241
- **Practice address phone:** (208) 381-2185
- **Mailing address:** 1601 E 17TH ST, IDAHO FALLS, ID 83404-6313
- **Mailing address phone:** (208) 525-2090
- **Mailing address fax:** (208) 523-8978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA-325 | ID | Yes |

## Other

- **Enumeration date:** 09/27/2012
- **Last updated:** 09/27/2012