Organization
IDAHO SURGICAL ASSISTANTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REANNA PARK (BILLING SPECIALIST)
(208) 525-2090
Entity
Organization
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2185
Mailing address
1601 E 17TH ST, IDAHO FALLS, ID 83404-6313
(208) 525-2090
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-325
ID
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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