Provider Demographics
NPI:1720776164
Name:MOUNTAIN STATE BREAST & GENERAL SURGERY PLLC
Entity Type:Organization
Organization Name:MOUNTAIN STATE BREAST & GENERAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MENEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-392-3354
Mailing Address - Street 1:1525 S OWYHEE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6014
Mailing Address - Country:US
Mailing Address - Phone:208-392-3354
Mailing Address - Fax:
Practice Address - Street 1:1525 S OWYHEE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6014
Practice Address - Country:US
Practice Address - Phone:714-812-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty