Organization
MAPLE GROVE SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW NEALE MD (MEDICAL DIRECTOR)
(204) 344-7944
Entity
Organization
Contact information
Practice address
8955 W HACKAMORE DR, BOISE, ID 83709-1673
(208) 344-7944
Mailing address
8955 W HACKAMORE DR, BOISE, ID 83709-1673
(208) 344-7944
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Enumeration date
08/22/2022
Last updated
02/02/2024
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