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Organization

MADISON AVENUE SURGERY CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARK EDWARD FREEMAN MD (PRESIDENT)
(208) 881-5351
Entity
Organization

Contact information

Practice address
3760 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7593
(208) 881-5351
Mailing address
3760 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7593
(208) 881-5351

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Enumeration date
12/16/2015
Last updated
12/16/2015
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