Provider Demographics
NPI:1689349219
Name:EVEREST ASC
Entity Type:Organization
Organization Name:EVEREST ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SWANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-992-4119
Mailing Address - Street 1:2960 EAST ST LUKES ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-992-4111
Mailing Address - Fax:
Practice Address - Street 1:2960 E ST LUKES ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-378-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVEREST SURGICAL INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-16
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1184652364Medicaid