Provider Demographics
NPI:1962790964
Name:UROLOGY CENTER OF IDAHO PLLC
Entity type:Organization
Organization Name:UROLOGY CENTER OF IDAHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BJORN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUERWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-233-3355
Mailing Address - Street 1:500 S 11TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4835
Mailing Address - Country:US
Mailing Address - Phone:208-233-3355
Mailing Address - Fax:208-232-6118
Practice Address - Street 1:500 S 11TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4835
Practice Address - Country:US
Practice Address - Phone:208-233-3355
Practice Address - Fax:208-232-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9971208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty