Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Henrys Fork Surgery Center PLLC

Organization Ambulatory Surgical Clinic/Center · NPI 1235768490

Henrys Fork Surgery Center PLLC is an Ambulatory Surgical Clinic/Center in Rexburg, Idaho. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

23 Sawtelle Ave
Rexburg, ID 83440
Phone: (208) 359-1888
Fax: (208) 359-1889
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ambulatory Surgical Clinic/Center (primary) Taxonomy 261QA1903X

Record details

NPI number1235768490
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeremy Johnson — Manager · (208) 359-1888
NPI enumeratedApril 8, 2020
Last updated in NPPESJune 19, 2025
Certification dateMay 20, 2025
Mailing addressPo Box 6, Rexburg, ID 83440-0006

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