Organization
PARKWAY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J LEE M.D. (CO-MANAGER)
(208) 785-5100
Entity
Organization
Contact information
Practice address
1485 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-5100
(208) 785-5112
Mailing address
1485 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-5100
(208) 785-5112
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
NO LICENSE REQUIRED
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275645574
—
ID
Enumeration date
06/06/2012
Last updated
06/06/2012
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