NPI age
19 years
Enumerated 2006-06-17
● Active Type 2 · Organization
Rexburg Surgery Center Llc
Rexburg Surgery Center Llc is 1 of 99 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Hansen
Board Chairman
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 99 active clinic/center providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2006 → 2026
2006-06Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
381 East 4th North, Suite 200
Rexburg, ID 83440
Mailing address
381 East 4th North, Suite 200
Rexburg, ID 83440
Authorized official
Dwayne M Hansen, M.D.
Board Chairman
📞 2083592300
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Dwayne Hansen, M.D. Surgery NPI 1376581546
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010158869 | BLUE SHIELD PROVIDER NUMB |
| 01 (ID) | 04870 | BLUE CROSS PROVIDER NUMBE |
| 05 (ID) | 80760000 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
North Fork Surgery Center
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.