IDAHO SURGICAL, LLC (NPI# 1790340834) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790340834 |
| Entity Type | Organization |
| Organization Name | IDAHO SURGICAL, LLC |
| Practice Address |
6195 E Hunt Ave Nampa ID 83687-8317 |
| Mailing Address |
1662 S Lake Crest Way Eagle ID 83616-7142 |
| Practice Telephone | 2086394900 |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2019-06-14 |
| Authorized Official Name | DR. BREN HEATON (SURGEON/OWNER) |
| Authorized Official Telephone | 2088549828 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1629244355 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 222 N 2nd St Ste 115, Boise, ID 837026129 | 2086394900 |
| Street Address |
6195 E HUNT AVE |
| City | NAMPA |
| State | ID |
| Zip Code | 83687-8317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699307447 | Current Physical Therapy Nampa LLC | Physical Therapist | 16150 N High Desert Street, Nampa, ID 83687 | 2020-02-10 |
| 1356867683 | Nampa of Cascadia, LLC | Skilled Nursing Facility | 900 North Happy Valley Rd, Nampa, ID 83687 | 2017-08-18 |
| 1750828513 | Daniel & Max, LLC | Optometrist | 1600 Karcher Rd, Nampa, ID 83687 | 2017-01-31 |
| 1578965422 | Jorge Domingo Reyes | Counselor | 5700 E. Franklin Rd., Suite 220-i, Nampa, ID 83687 | 2014-09-23 |
| 1619302080 | David Lyle Farris | Dentist | 16548 North Franklin Blvd., Nampa, ID 83687 | 2013-09-04 |
| 1871934547 | Ian Zafar Qureshi | Internal Medicine | 4400 E Flamingo Ave Ste 130, Nampa, ID 83687 | 2013-07-10 |
| 1457696783 | Laurel Evans | Specialist/Technologist | 850 W. St. Luke's Dr., Suite 215, Nampa, ID 83687 | 2012-11-27 |
| 1750641197 | Andrea Patricia Fitzer | Nurse Practitioner | 4400 E. Flamingo Ave, Nampa, ID 83687 | 2012-05-18 |
| 1679846182 | Ivony Case Management | Case Management | 811 12th Street, Ste. 2, Nampa, ID 83687 | 2012-02-14 |
| 1699043679 | Saltzer Medical Group, P.a. | Durable Medical Equipment & Medical Supplies | 9850 W St Lukes Drive, Nampa, ID 83687 | 2011-12-06 |
| Find all providers in zip 83687 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245493840 | Forrest R Fredline | Surgery | 4400 E Flamingo Ave Ste 200, Nampa, ID 83687 | 2008-07-03 |
| 1235322660 | Dennis Weiler | Surgery | 3918 Chicago St, Nampa, ID 83686-8909 | 2007-08-20 |
| 1588769301 | Mark S Chown Mdpa | Surgery | 1611 C 12th Ave Rd, Nampa, ID 83686-6182 | 2006-09-14 |
| 1487766465 | Dynamic Surgical Care, Inc. | Surgery | 1603 12th Ave Rd Ste E, Nampa, ID 83686-6100 | 2006-08-31 |
| 1285698571 | Richard J Martin | Surgery | 4400 E Flamingo, Ste 200, Nampa, ID 83687 | 2006-04-13 |
| 1376506097 | Kent A Kreuder | Surgery | 16433 N Midland Blvd, 204, Nampa, ID 83687-5222 | 2006-04-11 |
| 1366952285 | Andrea Cortes Dobson | Surgery | 4400 E Flamingo Ave, Ste 200, Nampa, ID 83687 | 2017-10-05 |
| 1902154149 | Amber Taylor | Surgery | 4400 E Flamingo Ave Ste 200, Nampa, ID 83687-9203 | 2012-08-20 |
| 1215990981 | Ronald William Cornwell | Surgery | 4400 E Flamingo Ave, Ste 200, Nampa, ID 83687 | 2006-04-11 |
| 1255321261 | Christian P Vetsch | Surgery | 215 E Hawaii Ave, Nampa, ID 83686-6011 | 2005-10-21 |
| Find all providers in NAMPA | ||||
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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.