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Organization
MEADOW LAKE SURGERY CENTER INC
Active
Organization
MEADOW LAKE SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D WIGOD M.D. (M.D.)
(208) 377-9515
Entity
Organization
Contact information
Practice address
3630 E LOUISE DR, SUITE 200, MERIDIAN, ID 83642-7975
(208) 377-9515
(208) 377-9517
Mailing address
3630 E LOUISE DR, SUITE 200, MERIDIAN, ID 83642-7975
(208) 377-9515
(208) 377-9517
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
M8189
ID
Other
Enumeration date
10/18/2007
Last updated
09/16/2013
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