Organization
SURGERY CENTER OF IDAHO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD MICHAEL WALDMANN M.D. (PRESIDENT)
(208) 639-4900
Entity
Organization
Contact information
Practice address
2855 E MAGIC VIEW DR, MERIDIAN, ID 83642-6245
(208) 639-4900
(208) 639-4919
Mailing address
2855 E MAGIC VIEW DR, MERIDIAN, ID 83642-6245
(208) 639-4900
(208) 639-4919
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157600
BLUE SHIELD MERIDIAN
ID
01
—
04868
BLUE CROSS MERIDIAN
ID
05
—
1870688
—
ID
05
—
807589100
—
ID
Enumeration date
05/09/2006
Last updated
02/22/2021
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