Healthcare Provider Details

I. General information

NPI: 1649710351
Provider Name (Legal Business Name): SEI MOBILE ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N 18TH AVE SUITE A
POCATELLO ID
83201-3326
US

IV. Provider business mailing address

PO BOX 4107
POCATELLO ID
83205-4107
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-8880
  • Fax: 208-232-1950
Mailing address:
  • Phone: 208-233-8880
  • Fax: 208-232-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL GILBERT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 208-233-8880