Organization
PEND OREILLE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTI SABO RN (EXECUTIVE DIRECTOR)
(208) 265-8194
Entity
Organization
Contact information
Practice address
30544 HIGHWAY 200, SUITE 201, PONDERAY, ID 83852-5005
(208) 265-8194
(208) 265-4870
Mailing address
30544 HIGHWAY 200, SUITE 201, PONDERAY, ID 83852-5005
(208) 265-8194
(208) 265-4870
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808553900
—
ID
Enumeration date
02/06/2008
Last updated
04/27/2012
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