Provider Demographics
NPI:1497745178
Name:SURGERY CENTER
Entity Type:Organization
Organization Name:SURGERY CENTER
Other - Org Name:DBA SAWTOOTH SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WENSINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-1662
Mailing Address - Street 1:115 FALLS AVE W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-733-1662
Mailing Address - Fax:208-734-1023
Practice Address - Street 1:115 FALLS AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-733-1662
Practice Address - Fax:208-734-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID04473OtherBLUE CROSS OF IDAHO PPO
000010004906OtherREGENCE BLE SHIELD
ID00331OtherBLUE CROSS OF ID TRAD
ID805302100Medicaid
ID00331OtherBLUE CROSS OF ID