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NPI Code Detail

MEDICARE: ANESTHESIA ASSOCIATES OF LARAMIE LLC

MEDICARE: ANESTHESIA ASSOCIATES OF LARAMIE LLC
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
1207L00000XAnesthesiology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1548364888
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANESTHESIA ASSOCIATES OF LARAMIE LLC
Provider Business Mailing Address
First Line : PO BOX 1562
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83403-1562
Country : US
Telephone Number : 208-525-2090
Fax Number : 208-523-8978
Provider Business Practice Location Address
First Line : 255 N 30TH ST
Second Line :
City : LARAMIE
State : WY
Zip : 82072-5140
Country : US
Telephone Number : 307-742-2141
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. JOHN DAVID CRECCA
Credential : M.D.
Telephone Number : 307-760-9897
Provider Enumeration Date : 09/08/2006
Last Update Date : 10/10/2016

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Directions to “ANESTHESIA ASSOCIATES OF LARAMIE LLC ” Practice Location

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