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NPI Code Detail

MEDICARE: MADISON ANESTHESIA SERVICES PA

MEDICARE: MADISON ANESTHESIA SERVICES 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
1207L00000XAnesthesiology Physician
2367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1558392571
Entity Type Code : Organization
Provider Name (Legal Business Name) : MADISON ANESTHESIA SERVICES PA
Provider Business Mailing Address
First Line : PO BOX 3882
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83403-3882
Country : US
Telephone Number : 208-525-2090
Fax Number : 208-525-2662
Provider Business Practice Location Address
First Line : 450 E MAIN ST
Second Line :
City : REXBURG
State : ID
Zip : 83440-2048
Country : US
Telephone Number : 208-356-3691
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CINDI FARNWORTH
Credential : CRNA
Telephone Number : 208-359-6564
Provider Enumeration Date : 07/06/2006
Last Update Date : 04/21/2010

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Directions to “MADISON ANESTHESIA SERVICES PA ” Practice Location

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