Healthcare Provider Details

I. General information

NPI: 1457658668
Provider Name (Legal Business Name): SURGERY CENTER ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E 17TH ST
IDAHO FALLS ID
83404-6429
US

IV. Provider business mailing address

PO BOX 52180
IDAHO FALLS ID
83405-2180
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-1945
  • Fax:
Mailing address:
  • Phone: 208-552-8776
  • Fax: 208-523-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KEITH W SCHEUERMANN
Title or Position: SECRETARY/TREASURERE
Credential: MD
Phone: 208-529-1945