Healthcare Provider Details

I. General information

NPI: 1962440966
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF COEUR D ALENE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W IRONWOOD DR STE 250
COEUR D ALENE ID
83814-1415
US

IV. Provider business mailing address

PO BOX 35145 #40023
SEATTLE WA
98124-5145
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-8585
  • Fax:
Mailing address:
  • Phone: 425-407-1500
  • Fax: 425-407-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIK J PAYNE
Title or Position: MEMBER
Credential: M.D.
Phone: 208-771-3722