Healthcare Provider Details

I. General information

NPI: 1174468011
Provider Name (Legal Business Name): IDAHO ANESTHESIA PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S VANGUARD WAY STE 300
MERIDIAN ID
83642-8613
US

IV. Provider business mailing address

2960 EAST ST. LUKE'S STREET STE 400
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-488-0066
  • Fax:
Mailing address:
  • Phone: 208-488-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY POWELL
Title or Position: MANAGER
Credential: CRNA
Phone: 360-489-5766