NPIMap

Organization Active NPI

Rexburg Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Rexburg, ID
National Provider Identifier
1831134584
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
REXBURG SURGERY CENTER LLC
Practice address
381 East 4TH North
Suite 200
Rexburg, ID 83440
Phone
(208) 359-2300
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dwayne M Hansen, M.D.NPI 1376581546
Title
Board Chairman
Phone
(208) 359-2300

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 ID Primary

Addresses

Primary practice location

381 East 4TH North
Suite 200
Rexburg, ID 83440

Mailing address

381 East 4TH North
Suite 200
Rexburg, ID 83440
Phone (208) 359-2300

Other identifiers 3

IdentifierTypeStateIssuer
000010158869OtherIDBLUE SHIELD PROVIDER NUMB
04870OtherIDBLUE CROSS PROVIDER NUMBE
80760000MedicaidID

Other names 1

  • North Fork Surgery Center Doing business as

National Provider Directory

National Provider Directory

Locations

381 E 4th N
#200
Rexburg, ID 83440
Phone (208) 359-2300

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": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831134584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 EAST 4TH NORTH",
            "address_2": "SUITE 200",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-359-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 EAST 4TH NORTH",
            "address_2": "SUITE 200",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-359-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REXBURG SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BOARD CHAIRMAN",
        "authorized_official_telephone_number": "208-359-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "000010158869",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "04870",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80760000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Fork Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.