SURGICARE CENTER OF IDAHO, LLC (NPI# 1114923471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114923471 |
| Entity Type | Organization |
| Organization Name | SURGICARE CENTER OF IDAHO, LLC |
| Practice Address |
360 E Mallard Dr Ste 125 Boise ID 83706-3941 |
| Mailing Address |
360 E Mallard Dr Ste 125 Boise ID 83706-6644 |
| Practice Telephone | 2083368700 |
| Practice Fax Number | 2084260902 |
| Mailing Telephone | 2083368700 |
| Mailing Fax Number | 2084260902 |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2016-10-10 |
| Authorized Official Name | MR. LOUIS PENNOW (DIRECTOR) |
| Authorized Official Telephone | 2083368700 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QS0132X |
Clinic/Center Specialization: Ophthalmologic Surgery |
Ambulatory Health Care Facilities | ||
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 273390 | 05 |
| Street Address |
360 E MALLARD DR STE 125 |
| City | BOISE |
| State | ID |
| Zip Code | 83706-3941 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982994844 | Ryan Thomas Barrett | Ophthalmology | 360 E Mallard Dr, Ste 110, Boise, ID 83706-3945 | 2011-04-12 |
| 1871643585 | Hollingshead Eye Center, PC | Optometrist | 360 E Mallard Dr, Suite 110, Boise, ID 83706-6644 | 2007-01-12 |
| 1093894107 | Linda M Evans | Nurse Anesthetist, Certified Registered | 360 E Mallard Dr, Suite 125, Boise, ID 83706-6644 | 2006-11-02 |
| 1326095233 | Christi Alise Campbell | Registered Nurse | 360 E Mallard Dr, #110, Boise, ID 83706-6644 | 2006-05-27 |
| 1821094152 | Brian J Mcneel | Optometrist | 360 E Mallard Dr, Ste 110, Boise, ID 83706-3945 | 2005-06-22 |
| 1689670911 | Mark E Hollingshead | Ophthalmology | 360 E Mallard Dr, Ste 110, Boise, ID 83706-3945 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558733147 | River City Surgical Center | Clinic/Center | 10118 W Overland Rd, Boise, ID 83709-1428 | 2015-10-22 |
| 1255500427 | Les Bois Surgery Center, LLP | Clinic/Center | 8950 W Emerald St Ste 164, Boise, ID 83704-8296 | 2008-02-21 |
| 1902960206 | Sinus Surgery Center Idaho Pa | Clinic/Center | 727 E River Park Ln, Suite 200, Boise, ID 83706-4097 | 2006-12-20 |
| 1316961089 | Orthopedic Surgery Center of Idaho, LLC | Clinic/Center | 1425 W River St, Boise, ID 83702-6861 | 2006-07-27 |
| 1750884052 | Precision Surgery Center Pllc | Clinic/Center | 900 N Liberty St Ste 300, Boise, ID 83704-8729 | 2018-03-13 |
| 1629597216 | Genesis Surgery Center | Clinic/Center | 8950 W Emerald St Ste 164, Boise, ID 83704-8296 | 2017-09-14 |
| 1750616249 | Idaho Endoscopy Center LLC | Clinic/Center | 6259 W Emerald St, Boise, ID 83704-8731 | 2009-10-16 |
| 1548433790 | Ada Plastic and Reconstructive Surgery | Clinic/Center | 900 N Liberty St, Suite 300, Boise, ID 83704-8704 | 2008-04-09 |
| 1023228558 | Boise Gastroenterology Associates | Clinic/Center | 6259 W Emerald St, Boise, ID 83704-8731 | 2007-05-23 |
| 1477619005 | Southwest Idaho Surgery Center, Inc. | Clinic/Center | 900 N Liberty St, Suite 450, Boise, ID 83704-8704 | 2006-12-28 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.