Idaho Falls Surgical Center

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

IDAHO FALLS SURGICAL CENTER

Practice address

1945 E 17TH St
Idaho Falls, ID 83404-6429

Phone

(208) 529-1945

NPI assigned

May 16, 2008

Organization subpart

No

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

Authorized official

Name

Mark L. Petersen, MD

Title

President

Phone

(208) 529-1945

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Idaho Falls Surgical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Idaho Falls Surgical Center

  • Durable Medical Equipment & Medical Supplies
  • Idaho Falls, ID
  • NPI 1821303298
  NPD tax ID

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1952568099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52180",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834052180",
            "telephone_number": "208-529-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046429",
            "telephone_number": "208-529-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO FALLS SURGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-529-1945",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB0412",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806687900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idaho Falls School District 91
• Idaho Falls Smiles, PLLC
• Idaho Falls Surcigal Center
• Idaho Falls Surgical Center
• Idaho Falls Surgical Center
• Idaho Falls Surgical Specialists, PLLC
• Idaho Family Vision PLLC
• Idaho Foot Center
• Idaho Foot Center PC
• Idaho Foot Surgery Center PC

• Certified Registered Nurse Anesthetist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.