Provider Demographics
NPI:1457345530
Name:SYRINGA SURGICAL CENTER
Entity Type:Organization
Organization Name:SYRINGA SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-298-0103
Mailing Address - Street 1:1630 23RD AVE
Mailing Address - Street 2:SUITE 901B
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6353
Mailing Address - Country:US
Mailing Address - Phone:208-298-0103
Mailing Address - Fax:208-746-8566
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:SUITE 901B
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6350
Practice Address - Country:US
Practice Address - Phone:208-298-0103
Practice Address - Fax:208-746-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1870596Medicare ID - Type Unspecified
IDG06549Medicare UPIN