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BONNEVILLE SURGERY CENTER LLC
NPI 1366256943
Clinic/Center - Ambulatory Surgical in Idaho Falls, ID

Active since February 04, 2025CLIA 13D2324806 · Waiver
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404(208) 715-8220(208) 715-8221 Get Directions Write a Review

NPPES record last updated: February 4, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Bonneville Surgery Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BONNEVILLE SURGERY CENTER LLC (NPI 1366256943) is a healthcare organization registered as an ambulatory surgical in Idaho Falls, Idaho and active in the NPI registry since February 2025. The organization holds a CLIA Waiver certificate valid through June 1, 2027 and lists Derek Van Orden, Secretary, as its authorized official.

NPPES Registry Identity

NPI1366256943
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameBONNEVILLE SURGERY CENTER LLC
Location Address2001 S WOODRUFF AVE STE 6Idaho Falls, ID 83404-6371
Mailing Address2001 S Woodruff Ave Ste 6Idaho Falls, ID 83404-6371 · (208) 715-8220 · Fax (208) 715-8221
Phone(208) 715-8220
Fax(208) 715-8221
Organization SubpartNo
Authorized OfficialDerek Van OrdenSecretary · (208) 715-8220
Enumeration DateFebruary 4, 2025
NPPES CertifiedFebruary 4, 2025
✔ NPI 1366256943 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
2001 S WOODRUFF AVE STE 6, Idaho Falls, ID 83404
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2324806

Bonneville Surgery Center LLC · Idaho Falls, ID
Active · expires Jun 1, 2027
CLIA Number13D2324806
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJune 2, 2025
Certificate Expiration DateJune 1, 2027
Laboratory DirectorLuke W. Orourke
Laboratory Phone(208) 715-8220
Laboratory LocationBonneville Surgery Center LLC2001 S Woodruff Ave Ste 6, Idaho Falls, ID 83404
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELE OSMOND
Counselor
2001 S WOODRUFF AVE STE 6
IDAHO FALLS, ID 83404
Bonneville County (208) 529-4673
PARAGON ANESTHESIA LLC
Nurse Anesthetist, Certified Registered
2001 S WOODRUFF AVE STE 6
IDAHO FALLS, ID 83404
Bonneville County (208) 715-8220
SUZANNE GODFREY
Counselor
2001 S WOODRUFF AVE STE 6
IDAHO FALLS, ID 83404
Bonneville County (208) 529-4673

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonneville Surgery Center LLC's NPI number?

The NPI number for Bonneville Surgery Center LLC is 1366256943. It was assigned to this organization in the NPPES registry on February 4, 2025.

Where is Bonneville Surgery Center LLC located?

Bonneville Surgery Center LLC is located at 2001 S Woodruff Ave Ste 6, Idaho Falls, ID 83404. The listed phone number is (208) 715-8220.

What is Bonneville Surgery Center LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does Bonneville Surgery Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2324806) is associated with this NPI, valid through June 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bonneville Surgery Center LLC was last updated on February 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.