Healthcare Provider Details

I. General information

NPI: 1316146608
Provider Name (Legal Business Name): PRECISION ANESTHESIA, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

PO BOX 274
HERMISTON OR
97838-0274
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3400
  • Fax:
Mailing address:
  • Phone: 541-564-4466
  • Fax: 541-564-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. TOBY PENNER
Title or Position: PRESIDENT
Credential: CRNA
Phone: 541-564-4466