Organization
IDAHO SURGICENTER INC
Active
Other names
Idaho SurgiCenter South
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN BARNARD (ADMINISTRATOR)
(208) 852-6242
Entity
Organization
Contact information
Practice address
1157 CALL PLACE, POCATELLO, ID 83201
(208) 238-6337
(208) 776-5510
Mailing address
PO BOX 2067, POCATELLO, ID 83206-2067
(208) 238-6337
(208) 776-5510
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
P153
ID
213ES0103X
Foot & Ankle Surgery Podiatrist
P166
ID
213ES0103X
Foot & Ankle Surgery Podiatrist
P92
ID
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010027108
BLUE SHIELD
ID
01
—
03913
BLUE CROSS
ID
05
—
805730900
—
ID
05
—
807288200
—
ID
01
—
P00091636
RAILROAD MEDICARE
ID
Enumeration date
05/22/2006
Last updated
01/31/2022
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