Organization
MCKIM SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS D MCKIM M.D. (OWNER)
(208) 367-6901
Entity
Organization
Contact information
Practice address
900 N LIBERTY ST STE 300, BOISE, ID 83704-8729
(208) 367-6901
(208) 367-6904
Mailing address
900 N LIBERTY ST STE 300, BOISE, ID 83704-8729
(208) 367-6901
(208) 367-6904
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
M7009
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147715
BLUE SHIELD
ID
01
—
04366
BLUE CROSS OF IDAHO
ID
Enumeration date
08/23/2006
Last updated
08/22/2020
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