Organization Name:  AMBULATORY SURGERY CENTER OF BURLEY, LLC


Practice Location:
1344 HILAND AVE SUITE E BURLEY, ID 83318 US
Tel: 208-677-8888  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	367500000X	Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center

Other Provider Identifiers:

Issuer	Number	State	Type
BLUE SHIELD	24973 000010005417	ID	01
	805534000	ID	05
BLUE CROSS	03822	ID	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin