Healthcare Provider Details

I. General information

NPI: 1568202026
Provider Name (Legal Business Name): SUMMIT ANESTHESIA ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PONDERA ST
KALISPELL MT
59901-1484
US

IV. Provider business mailing address

PO BOX 2503
IDAHO FALLS ID
83403-2503
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-6887
  • Fax:
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-523-8978

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: ROBERT MILLER
Title or Position: OWNER
Credential: CRNA
Phone: 601-942-1308