Organization
BONNEVILLE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK VAN ORDEN (SECRETARY)
(208) 715-8220
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404-6371
(208) 715-8220
(208) 715-8221
Mailing address
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404-6371
(208) 715-8220
(208) 715-8221
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2025
Last updated
02/04/2025
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