Provider Demographics
NPI:1902960206
Name:SINUS SURGERY CENTER IDAHO PA
Entity type:Organization
Organization Name:SINUS SURGERY CENTER IDAHO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-433-9300
Mailing Address - Street 1:3085 E MAGIC VIEW DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3745
Mailing Address - Country:US
Mailing Address - Phone:208-433-9300
Mailing Address - Fax:208-433-9854
Practice Address - Street 1:3085 E MAGIC VIEW DR STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3745
Practice Address - Country:US
Practice Address - Phone:208-433-9300
Practice Address - Fax:208-433-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical