# JACKSON HOLE ANESTHESIA SERVICES

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

## Provider details

- **NPI number:** 1942364567
- **Authorized official:** PHILIP C BLUM MD (PRESIDENT)
- **Authorized official phone:** (208) 525-2090

## Contact information

- **Practice address:** 150 BUFFALO WAY, JACKSON, WY 83002
- **Practice address phone:** (307) 733-8677
- **Mailing address:** 1601 E 17TH ST, IDAHO FALLS, ID 83404-6313
- **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 |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 12/20/2006
- **Last updated:** 06/19/2008