OrganizationIdaho Surgical Assistants PllcPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address190 E Bannock St, Boise, ID 83712-6241(208) 381-2185(208) 525-2090PECOS EnrollmentBased on the most recent information from CMS, provider Idaho Surgical Assistants Pllc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1225389414Provider TypeOrganizationFull NameIdaho Surgical Assistants PllcSubpartNoEnumeration Date9/27/2012Last Updated9/27/2012Contact InformationPractice LocationPractice Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-2185FaxUnlisted FaxMailing LocationMailing Address1601 E 17th St, Idaho Falls, ID 83404-6313Phone(208) 525-2090Fax(208) 523-8978Authorized OfficialNamePark, Reanna (Billing Specialist)Phone(208) 525-2090Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA-325Idaho