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General NPI Number Information
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NPI Number | 1457658668
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER ANESTHESIA PLLC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1945 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6429
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Country | US
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Telephone | 208-529-1945
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52180
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City | IDAHO FALLS
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State | ID
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Zip | 83405-2180
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Country | US
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Telephone | 208-552-8776
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Fax | 208-523-2025
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Authorized Official
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Title or Position | SECRETARY/TREASURERE
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Name | DR. KEITH W SCHEUERMANN
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Credential | MD
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Telephone | 208-529-1945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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