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Organization
ADA PLASTIC AND RECONSTRUCTIVE SURGERY
Active
Organization
ADA PLASTIC AND RECONSTRUCTIVE SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS D MCKIM M.D. (OWNING PHYSICIAN)
(208) 367-6901
Entity
Organization
Contact information
Practice address
900 N LIBERTY ST, SUITE 300, BOISE, ID 83704-8704
(208) 367-6903
(208) 367-6904
Mailing address
900 N LIBERTY ST, SUITE 300, BOISE, ID 83704-8704
(208) 367-6903
(208) 367-6904
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
M7009
ID
Other
Enumeration date
04/09/2008
Last updated
04/11/2008
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