Organization
PCS ENDOSCOPY SUITE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK L. MANSFIELD MD (PRESIDENT)
(208) 234-0024
Entity
Organization
Contact information
Practice address
110 VISTA DRIVE, POCATELLO, ID 83201-4835
(208) 234-0024
Mailing address
110 VISTA DRIVE, POCATELLO, ID 83201-4835
(208) 234-0024
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/27/2006
Last updated
09/18/2012
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