HENRYS FORK SURGERY CENTER PLLC – NPI #1235768490
Clinic/Center

HENRYS FORK SURGERY CENTER PLLC is an AHC clinic located in REXBURG, ID. NPPES has assigned the NPI number 1235768490 to HENRYS FORK SURGERY CENTER PLLC on April 08, 2020. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was last updated on Jun 19, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for HENRYS FORK SURGERY CENTER PLLC below.

NPI Profile for
HENRYS FORK SURGERY CENTER PLLC

NPI Number
1235768490
Enumeration Date

(more than 6 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
HENRYS FORK SURGERY CENTER PLLC
Primary location
23 SAWTELLE AVE
REXBURG, ID 83440
Phone: (208) 359-1888 Fax: (208) 359-1889
Mailing address
PO BOX 6
REXBURG, ID 83440-0006
Phone: (208) 359-1888 Fax: (208) 359-1888
Organization Subpart
No
Authorized Official
JEREMY JOHNSON
MANAGER
Phone: (208) 359-1888
Updated
Certification Date
May 20, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for HENRYS FORK SURGERY CENTER PLLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidID1447301395
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
[email protected]
Endpoint type
Direct Messaging Address
Endpoint Description
MANAGER EMAIL
Content Type
OTHER
Affiliation
N
Endpoint Location
23 SAWTELLE AVE,
REXBURG, ID 77025-1669