Provider Demographics
NPI:1902854433
Name:CAPITAL SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:CAPITAL SURGICAL ASSOCIATES, PA
Other - Org Name:ORTHOPAEDIC ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-321-4790
Mailing Address - Street 1:8854 W EMERALD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4845
Mailing Address - Country:US
Mailing Address - Phone:208-321-4790
Mailing Address - Fax:208-321-4836
Practice Address - Street 1:8854 W EMERALD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4845
Practice Address - Country:US
Practice Address - Phone:208-321-4790
Practice Address - Fax:208-321-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807082700Medicaid
IDDC4854OtherTRAVELERS MEDICARE
ID290408OtherREGENCE BLUE SHIELD
ID89466OtherBLUE CROSS
ID290408OtherREGENCE BLUE SHIELD