Healthcare Provider Details

I. General information

NPI: 1871195131
Provider Name (Legal Business Name): POST FALLS ANESTHESIA GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N CALGARY CT STE 203
POST FALLS ID
83854-4000
US

IV. Provider business mailing address

602 N CALGARY CT STE 203
POST FALLS ID
83854-4000
US

V. Phone/Fax

Practice location:
  • Phone: 208-660-8814
  • Fax: 208-550-3468
Mailing address:
  • Phone: 208-660-8814
  • Fax: 208-550-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY S BARLOW
Title or Position: OWNER
Credential: DDS
Phone: 208-660-8814