Provider Demographics
NPI:1609983089
Name:INTERMOUNTAIN SURGERY CENTER
Entity Type:Organization
Organization Name:INTERMOUNTAIN SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-489-4206
Mailing Address - Street 1:600 ROBBINS RD
Mailing Address - Street 2:STE 401
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4539
Mailing Address - Country:US
Mailing Address - Phone:208-383-0201
Mailing Address - Fax:208-489-4300
Practice Address - Street 1:600 N ROBBINS RD
Practice Address - Street 2:STE 401
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-383-0201
Practice Address - Fax:208-489-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID490005004OtherMEDICARE RAILROAD
ID04077OtherBLUE CROSS
ID185507800OtherUS DEPT OF LABOR
ID000010028431OtherBLUE SHIELD
ID805845600Medicaid
ID805845600Medicaid
ID4164700001Medicare NSC