Healthcare Provider Details

I. General information

NPI: 1316305519
Provider Name (Legal Business Name): QUALITY SLEEP ANESTHESIA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404
US

IV. Provider business mailing address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404-7534
US

V. Phone/Fax

Practice location:
  • Phone: 208-569-5818
  • Fax:
Mailing address:
  • Phone: 208-569-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberRNA382A
License Number StateID

VIII. Authorized Official

Name: MR. GREG D NEBEKER
Title or Position: NURSE ANESTHETIST
Credential: CRNA
Phone: 208-569-5818