Organization
GRANGE SURGERY CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANDON GRANGE MD (MEDICAL DIRECTOR)
(208) 506-7966
Entity
Organization
Contact information
Practice address
450 W STATE ST STE 250, EAGLE, ID 83616-6974
(208) 506-7966
Mailing address
450 W STATE ST STE 250, EAGLE, ID 83616-6974
(208) 506-7966
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Enumeration date
10/14/2022
Last updated
08/22/2023
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