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General NPI Number Information
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NPI Number | 1942343553
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Entity Type | Organization
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Legal Business Name | INDEPENDENT ANESTHESIA, PA
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 W BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83702-5233
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Country | US
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Telephone | 208-378-9295
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E 17TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6313
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Country | US
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Telephone | 208-525-2090
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Fax | 208-525-2662
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Authorized Official
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Title or Position | BILLING OFFICE MANAGER
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Name | CONNIE CROFT
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Credential |
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Telephone | 208-525-2090
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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 | RNA-246
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License Number State | ID
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