NPIMap

Organization Active NPI

Southern Idaho Surgery Center PLLC

  • Ambulatory Surgical Clinic/Center
  • Meridian, ID
National Provider Identifier
1396069902
Registry record updated Jul 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SOUTHERN IDAHO SURGERY CENTER PLLC
Practice address
3235 N Towerbridge Way Ste 100
Meridian, ID 83646-5721
Phone
(208) 895-6611
NPI assigned
Mar 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2012

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

Authorized official

Name
Dr. Marlon B Michel, MDNPI 1578664892
Title
President
Phone
(208) 895-6611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3235 N Towerbridge Way Ste 100
Meridian, ID 83646-5721

Mailing address

3235 N Towerbridge Way Ste 100
Meridian, ID 83646-5721
Phone (208) 895-6611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110527000154 ID Part B Supplier - Ambulatory Surgical Center 9830376987 Practice locations: Meridian, ID

Ambulatory surgical center certification: CCN 13C0001069

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SOUTHERN IDAHO SURGERY CENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Nov 16, 2011
Last certification
Jan 8, 2021
Ownership / control type
Proprietary
Facility address
3235 N Towerbridge Way, Suite 100
Meridian, ID 83646

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2106536Southern Idaho Surgery Center3235 N Towerbridge Way #100, Meridian, ID 83646Certificate of waiverDec 20, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1396069902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3235 N TOWERBRIDGE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465721",
            "telephone_number": "208-895-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3235 N TOWERBRIDGE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465721",
            "telephone_number": "208-895-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IDAHO SURGERY CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-25",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "MICHEL",
        "authorized_official_first_name": "MARLON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-895-6611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.