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

Mini-Cassia Surgical PC

Organization Surgery Physician · NPI 1457656217

Mini-Cassia Surgical PC is a Surgery Physician in Rupert, Idaho. Licensed in Idaho. Registered with an NPI since 2011.

Licensed in
ID
In the registry since
2011
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1218 9th St Ste 10
Rupert, ID 83350-2207
Phone: (208) 436-8340
Fax: (208) 436-3956
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence M7497 (ID)

Record details

NPI number1457656217
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Daclynn Johnson — President · (208) 436-8340
NPI enumeratedJanuary 25, 2011
Last updated in NPPESJanuary 25, 2011
Mailing address1218 9th St, Ste 10, Rupert, ID 83350-2207

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