1164515276 NPI number — HEALING ARTS DAY SURGERY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164515276 NPI number — HEALING ARTS DAY SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING ARTS 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:
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:
1164515276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 W IOWA AVE STE B
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83686-6814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-467-3432
Provider Business Mailing Address Fax Number:
208-467-4147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W IOWA AVE STE B
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83686-6814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-467-3432
Provider Business Practice Location Address Fax Number:
208-467-4147
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROITORU
Authorized Official First Name:
RAQUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
GASTROENTEROLOGIST
Authorized Official Telephone Number:
208-467-3432

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  M-5744 , 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: 805278000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010004965 . This is a "REGENCE BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0A453 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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