# GRAND ANESTHESIOLOGY SERVICES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477567246
- **Authorized official:** MR. MARC DOMSKY D.O. (PRESIDENT)
- **Authorized official phone:** (307) 739-7218

## Contact information

- **Practice address:** 625 E BROADWAY, JACKSON, WY 83001
- **Practice address phone:** (800) 877-7078
- **Practice address fax:** (307) 739-7446
- **Mailing address:** PO BOX 1501, IDAHO FALLS, ID 83403-1501
- **Mailing address phone:** (208) 525-2090
- **Mailing address fax:** (208) 525-2662

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 03/03/2008