Organization
IDAHO SURGICAL PARTNERS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMI YANTIS (ADMINISTRATOR)
(208) 649-8347
Entity
Organization
Contact information
Practice address
323 E RIVERSIDE DR STE 220, EAGLE, ID 83616-5246
(208) 343-5600
Mailing address
PO BOX 2045, EAGLE, ID 83616-9110
(208) 343-5600
(208) 779-2889
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6834
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002779400
—
ID
05
—
807305800
—
ID
Enumeration date
01/18/2007
Last updated
09/30/2024
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