NPIMap

Organization Active NPI

Idaho Surgical Assistants PLLC

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1225389414
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-325 Issued in ID
Legal business name
IDAHO SURGICAL ASSISTANTS PLLC
Practice address
190 E Bannock St
Boise, ID 83712-6241
Phone
(208) 381-2185
NPI assigned
Sep 27, 2012
Last updated
Sep 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Reanna Park
Title
Billing Specialist
Phone
(208) 525-2090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA-325 ID Primary

Addresses

Primary practice location

190 E Bannock St
Boise, ID 83712-6241

Mailing address

1601 E 17TH St
Idaho Falls, ID 83404-6313
Phone (208) 525-2090

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1225389414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046313",
            "telephone_number": "208-525-2090",
            "fax_number": "208-523-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO SURGICAL ASSISTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-27",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "REANNA",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "208-525-2090"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.