Provider Demographics
NPI:1134236433
Name:MCKIM SURGERY CENTER, INC
Entity type:Organization
Organization Name:MCKIM SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-367-6901
Mailing Address - Street 1:900 N LIBERTY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8729
Mailing Address - Country:US
Mailing Address - Phone:208-367-6901
Mailing Address - Fax:208-367-6904
Practice Address - Street 1:900 N LIBERTY ST STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8729
Practice Address - Country:US
Practice Address - Phone:208-367-6901
Practice Address - Fax:208-367-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7009261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010147715OtherBLUE SHIELD
ID04366OtherBLUE CROSS OF IDAHO
ID1870615Medicare ID - Type Unspecified
ID04366OtherBLUE CROSS OF IDAHO