Organization
SURGERY CENTER
Active
Other names
dba Sawtooth Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH A WENSINK (ADMINISTRATOR)
(208) 733-1662
Entity
Organization
Contact information
Practice address
115 FALLS AVE W, TWIN FALLS, ID 83301
(208) 733-1662
(208) 734-1023
Mailing address
115 FALLS AVE W, TWIN FALLS, ID 83301
(208) 733-1662
(208) 734-1023
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004906
REGENCE BLE SHIELD
—
01
—
00331
BLUE CROSS OF ID TRAD
ID
01
—
04473
BLUE CROSS OF IDAHO PPO
ID
05
—
805302100
—
ID
Enumeration date
10/25/2005
Last updated
08/10/2020
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