Organization
IDAHO FALLS SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK L PETERSEN MD (PRES)
(208) 529-1945
Entity
Organization
Contact information
Practice address
1945 E 17TH ST, IDAHO FALLS, ID 83404-6429
(208) 529-1945
Mailing address
PO BOX 52180, IDAHO FALLS, ID 83405-2180
(208) 552-8764
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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