Organization · Type 2 NPI

Idaho Endoscopy Center LLC

Ambulatory Surgical Clinic/Center · Nampa, ID

NPI number 1043835713 Active

Practice location

5080 E Commerce St
Nampa, ID 83687-5513

Call (986) 867-1600 Map

Fax (986) 867-1601

Mailing address

6259 W Emerald St
Boise, ID 83704-8731

Specialties and licenses

Taxonomy	Code	License
Ambulatory Surgical Clinic/Center Primary	261QA1903X	None listed

Ambulatory Surgical Clinic/Center: Definition to come...

4 other providers at this address

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NPI record

NPI: 1043835713
Entity type: Organization (Type 2)
Issued: Jun 9, 2020
Last updated: Jul 30, 2020
Status: Active
Subpart: Yes of Idaho Endoscopy Center LLC

Other names

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Nampa Idaho Endoscopy Center · doing business as
Nampa Idaho Endoscopy Center · doing business as

Authorized official

Mark A Mallory, MD
Manager
(208) 489-1900

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1043835713

Idaho Endoscopy Center LLC's National Provider Identifier is 1043835713, issued on Jun 9, 2020. The primary taxonomy on file is Ambulatory Surgical Clinic/Center (261QA1903X), and the practice location is in Nampa, ID. The record was last updated on Jul 30, 2020.