Organization
ADDISON SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BLACKMER DPM (MEDICAL DIRECTOR)
(208) 734-5993
Entity
Organization
Contact information
Practice address
191 ADDISON AVE, STE 1, TWIN FALLS, ID 83301-5177
(208) 734-5993
(208) 736-1968
Mailing address
191 ADDISON AVE, STE 1, TWIN FALLS, ID 83301-5177
(208) 734-5993
(208) 736-1968
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8042431
—
ID
Enumeration date
06/16/2005
Last updated
08/22/2020
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