HENRYS FORK SURGERY CENTER PLLC; NPI #1235768490

Contact Information

HENRYS FORK SURGERY CENTER PLLC

23 SAWTELLE AVE
REXBURG, ID 83440

Phone: 208-359-1888
Fax: 208-359-1889
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Ambulatory Surgical	261QA1903X	49	Ambulatory Surgical Center

Indicates primary specialty

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NPI Profile & details for HENRYS FORK SURGERY CENTER PLLC

NPI # 1235768490

LBN Legal business name HENRYS FORK SURGERY CENTER PLLC

Authorized official JEREMY JOHNSON - (MANAGER)

Entity Organization

Organization subpart ¹ No

Enumeration date 04/08/2020

Last updated 06/19/2025 - About 12 months ago

Identifiers

Medicaid

1447301395

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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