Organization
SUNNYSIDE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL K JAMES DPM (OWNER)
(208) 528-2858
Entity
Organization
Contact information
Practice address
3345 S HOLMES AVE STE B, IDAHO FALLS, ID 83404-7981
(208) 528-2858
(208) 528-8022
Mailing address
3345 S HOLMES AVE STE B, IDAHO FALLS, ID 83404-7981
(208) 528-2858
(208) 528-8022
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
P140-7
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010151664
BLUE SHIELD
ID
01
—
04804
BLUE CROSS
ID
Enumeration date
08/06/2007
Last updated
08/06/2007
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