Provider Demographics
NPI:1477619005
Name:SOUTHWEST IDAHO SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHWEST IDAHO SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:208-367-7431
Mailing Address - Street 1:900 N LIBERTY ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8704
Mailing Address - Country:US
Mailing Address - Phone:208-367-7431
Mailing Address - Fax:208-367-7433
Practice Address - Street 1:900 N LIBERTY ST
Practice Address - Street 2:SUITE 450
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8704
Practice Address - Country:US
Practice Address - Phone:208-367-7431
Practice Address - Fax:208-367-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1870219Medicare ID - Type UnspecifiedPROVIDER NUMBER