Provider Demographics
NPI:1104824739
Name:NORTH IDAHO DAY SURGERY LLC
Entity Type:Organization
Organization Name:NORTH IDAHO DAY SURGERY LLC
Other - Org Name:NORTHWEST SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-262-2320
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:1593 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5326
Practice Address - Country:US
Practice Address - Phone:208-262-2300
Practice Address - Fax:208-262-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
ID65282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1104824739Medicaid
ID00471OtherBLUE CROSS OF IDAHO
ID000010145102OtherREGENCE BLUE SHIELD
0179400OtherWASHINGTON WORKER COMP
ID1006277OtherSTATE INSURANCE FUND
23166OtherGROUP HEALTH
823016OtherFIRST HEALTH
ID1104824739Medicaid
=========OtherCHAMPUS
ID1006277OtherSTATE INSURANCE FUND
ID806752000Medicaid