Organization
MEDICAL SURGICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHN HOFFMAN (BUSINESS MANAGER)
(208) 743-0962
Entity
Organization
Contact information
Practice address
307 SAINT JOHNS WAY, SUITE 6, LEWISTON, ID 83501-2435
(208) 743-0962
Mailing address
307 SAINT JOHNS WAY, SUITE 6, LEWISTON, ID 83501-2435
(208) 743-0962
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
164590
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005483
REGENCE
ID
05
—
7025844
—
WA
01
—
8987-0
BLUE CROSS OF IDAHO
ID
Enumeration date
11/13/2006
Last updated
08/22/2020
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