Provider Demographics
NPI:1619370434
Name:SANDPOINT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SANDPOINT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISPIRESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-263-9757
Mailing Address - Street 1:1327 SUPERIOR ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1735
Mailing Address - Country:US
Mailing Address - Phone:208-501-8895
Mailing Address - Fax:208-965-8128
Practice Address - Street 1:1327 SUPERIOR ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1735
Practice Address - Country:US
Practice Address - Phone:208-501-8895
Practice Address - Fax:208-965-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDW137644261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical