Organization
IDAHO SURGICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BREN HEATON MD (SURGEON/OWNER)
(208) 854-9828
Entity
Organization
Contact information
Practice address
6195 E HUNT AVE, NAMPA, ID 83687-8317
(208) 639-4900
Mailing address
1662 S LAKE CREST WAY, EAGLE, ID 83616-7142
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629244355
—
ID
Enumeration date
05/03/2019
Last updated
06/14/2019
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