MEADOW LAKE SURGERY CENTER INC
NPI 1740479476
Clinic/Center - Ambulatory Surgical in Meridian, ID

Q: What is Meadow Lake Surgery Center Inc's NPI number?

The NPI number for Meadow Lake Surgery Center Inc is 1740479476. It was assigned to this organization in the NPPES registry on October 18, 2007.

Q: What is Meadow Lake Surgery Center Inc's specialty?

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

Active since October 18, 2007CLIA 13D2017234 · Waiver

3630 E LOUISE DR, SUITE 200, MERIDIAN, ID 83642(208) 377-9515(208) 377-9517 Get Directions Write a Review

NPPES record last updated: September 16, 2013. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Meadow Lake Surgery Center Inc NPPES

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

MEADOW LAKE SURGERY CENTER INC (NPI 1740479476) is a healthcare organization registered as an ambulatory surgical in Meridian, Idaho and active in the NPI registry since October 2007. The organization holds a CLIA Waiver certificate valid through December 6, 2026 and lists Mark D Wigod, M.d., as its authorized official.

NPPES Registry Identity

NPI1740479476

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameMEADOW LAKE SURGERY CENTER INC

Location Address3630 E LOUISE DR, SUITE 200Meridian, ID 83642-7975

Mailing Address3630 E Louise Dr, Suite 200Meridian, ID 83642-7975 · (208) 377-9515 · Fax (208) 377-9517

Phone(208) 377-9515

Fax(208) 377-9517

Organization SubpartNo

Authorized OfficialMark D WigodM.d. · (208) 377-9515

Enumeration DateOctober 18, 2007

Last NPPES UpdateSeptember 16, 2013

✔ NPI 1740479476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

License✔ Licensed in ID · M8189

3630 E LOUISE DR, Meridian, ID 83642

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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 13D2017234

Meadow Lake Surgery Center · Meridian, ID

Active · expires Dec 6, 2026

CLIA Number13D2017234

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateDecember 7, 2024

Certificate Expiration DateDecember 6, 2026

Laboratory DirectorMark D. Wigod

Laboratory Phone(208) 377-9515

Laboratory LocationMeadow Lake Surgery Center3630 E Louise Dr, Meridian, ID 83642

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 6

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

MARK D. WIGOD, MD, PA

Surgery (Plastic and Reconstructive Surgery)