Healthcare Provider Details

I. General information

NPI: 1558392571
Provider Name (Legal Business Name): MADISON ANESTHESIA SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E MAIN ST
REXBURG ID
83440-2048
US

IV. Provider business mailing address

PO BOX 3882
IDAHO FALLS ID
83403-3882
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-3691
  • Fax:
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CINDI FARNWORTH
Title or Position: PRESIDENT
Credential: CRNA
Phone: 208-359-6564