Provider Demographics
NPI:1578316709
Name:ASC IDAHO LLC.
Entity Type:Organization
Organization Name:ASC IDAHO LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDETN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LISKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-403-8451
Mailing Address - Street 1:800 W MAIN ST STE 1460
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5983
Mailing Address - Country:US
Mailing Address - Phone:208-593-2093
Mailing Address - Fax:208-593-2093
Practice Address - Street 1:800 W MAIN ST STE 1460
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5983
Practice Address - Country:US
Practice Address - Phone:208-593-2093
Practice Address - Fax:208-593-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care