MEDICARE: ANESTHESIOLOGY CONSULTANTS OF IDAHO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	C122890	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093703340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIOLOGY CONSULTANTS OF IDAHO PA

Provider Business Mailing Address
First Line	:	104 W 5TH AVE
Second Line	:	SUITE 250E
City	:	SPOKANE
State	:	WA
Zip	:	99204-4880
Country	:	US
Telephone Number	:	866-263-1223
Fax Number	:	509-835-4058

Provider Business Practice Location Address
First Line	:	1512 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6008
Country	:	US
Telephone Number	:	208-463-5029
Fax Number	:

Authorized Official
Title or Position	:	MD/OFFICER
Name	:	DR. STEVE ROBERTS
Credential	:
Telephone Number	:	208-463-5029

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/18/2012

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Directions to “ANESTHESIOLOGY CONSULTANTS OF IDAHO PA ” Practice Location

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