# IDAHO SURGICAL PARTNERS, PC

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

## Provider details

- **NPI number:** 1598817348
- **Authorized official:** AMI YANTIS (ADMINISTRATOR)
- **Authorized official phone:** (208) 649-8347

## Contact information

- **Practice address:** 323 E RIVERSIDE DR STE 220, EAGLE, ID 83616-5246
- **Practice address phone:** (208) 343-5600
- **Mailing address:** PO BOX 2045, EAGLE, ID 83616-9110
- **Mailing address phone:** (208) 343-5600
- **Mailing address fax:** (208) 779-2889

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M6834 | ID | Yes |

## Other

- **Enumeration date:** 01/18/2007
- **Last updated:** 09/30/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002779400 | — | ID |
| 05 | — | 807305800 | — | ID |