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General NPI Number Information
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NPI Number | 1912686882
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Entity Type | Organization
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Legal Business Name | NORTHSTAR ANESTHESIA OF IDAHO PLLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 777 HOSPITAL WAY
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City | POCATELLO
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State | ID
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Zip | 83201-5175
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Country | US
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Telephone | 208-239-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 N STATE HIGHWAY 161 STE 200
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City | IRVING
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State | TX
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Zip | 75038-2241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF QUALITY OFFICE
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Name | JOSHUA LUMBLEY
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Credential | MD
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Telephone | 617-935-5799
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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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