Organization
CENTER FOR SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY W. WALLACE MD (MEDICAL DIRECTOR)
(208) 524-8600
Entity
Organization
Contact information
Practice address
3369 MERLIN DR STE A, IDAHO FALLS, ID 83404-7405
(208) 524-8600
Mailing address
3369 MERLIN DR STE A, IDAHO FALLS, ID 83404-7405
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/11/2019
Last updated
11/25/2019
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