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General NPI Number Information
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NPI Number | 1568202026
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Entity Type | Organization
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Legal Business Name | SUMMIT ANESTHESIA ASSOCIATES PLLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1400 PONDERA ST
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City | KALISPELL
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State | MT
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Zip | 59901-1484
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Country | US
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Telephone | 406-756-6887
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2503
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2503
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT MILLER
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Credential | CRNA
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Telephone | 601-942-1308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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