=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265200364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERKINS ANESTHESIA SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2023
-----------------------------------------------------
Last Update Date | 12/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 2ND ST NE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-394-0125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1385
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83403-1385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-525-2090
-----------------------------------------------------
Fax | 208-523-8978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID L PERKINS
-----------------------------------------------------
Credential | CRNA
-----------------------------------------------------
Telephone | 707-628-9721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------