| Organization Name: | SURGICAL ASSOCIATES OF SOUTHERN ID |
| NPI Number: | 1033259700 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT SCHRADER (PRESIDENT) |
| Mailing Address: | 650 Addison Ave W Twin Falls |
| State: | ID US |
| Postal Code: | 833015444 |
| Phone Number: | 2087372112 |
| Fax Number: | |
| NPI Enumeration Date: | 02/08/2007 |
| NPI Last Update Date: | 01/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |