Provider Demographics
NPI:1245246875
Name:JEFFERSON DAY SURGERY CENTER
Entity Type:Organization
Organization Name:JEFFERSON DAY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-343-8907
Mailing Address - Street 1:220 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6044
Mailing Address - Country:US
Mailing Address - Phone:208-343-8907
Mailing Address - Fax:208-343-9161
Practice Address - Street 1:220 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6044
Practice Address - Country:US
Practice Address - Phone:208-343-8907
Practice Address - Fax:208-343-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1870137Medicare ID - Type UnspecifiedMEDICARE PROVIDER #