Organization
BLACKFOOT ANESTHESIA SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVE MCCLELLAN CRNA (MEMBER)
(208) 523-4906
Entity
Organization
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
PO BOX 829, BLACKFOOT, ID 83221-0829
(208) 523-4609
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC2767
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
03/07/2008
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