1104824739 NPI number — NORTH IDAHO DAY SURGERY LLC

Table of content: (NPI 1104824739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104824739 NPI number — NORTH IDAHO DAY SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IDAHO DAY SURGERY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104824739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1593 E POLSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83854-5326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-262-2300
Provider Business Mailing Address Fax Number:
208-262-2390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1593 E POLSTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-262-2300
Provider Business Practice Location Address Fax Number:
208-262-2390
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
PAYOR ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
208-618-2559

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 65 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000010145102 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 00471 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 823016 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1006277 . This is a "STATE INSURANCE FUND" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 23166 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0179400 . This is a "WASHINGTON WORKER COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104824739 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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