Provider Demographics
NPI:1336311224
Name:IDAHO CRH SURGEONS PC
Entity Type:Organization
Organization Name:IDAHO CRH SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTTENPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-284-7890
Mailing Address - Street 1:4040 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7874
Mailing Address - Country:US
Mailing Address - Phone:425-284-7890
Mailing Address - Fax:425-284-7896
Practice Address - Street 1:8854 W EMERALD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4844
Practice Address - Country:US
Practice Address - Phone:208-658-1774
Practice Address - Fax:208-321-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty