Provider Demographics
NPI:1821276353
Name:PEND OREILLE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PEND OREILLE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-265-8194
Mailing Address - Street 1:30544 HIGHWAY 200
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-5005
Mailing Address - Country:US
Mailing Address - Phone:208-265-8194
Mailing Address - Fax:208-265-4870
Practice Address - Street 1:30544 HIGHWAY 200
Practice Address - Street 2:SUITE 201
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-5005
Practice Address - Country:US
Practice Address - Phone:208-265-8194
Practice Address - Fax:208-265-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808553900Medicaid
1870013Medicare PIN