Organization
EAGLE ROCK ANESTHESIA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT C NELSON MD (MEMBER)
(208) 557-2700
Entity
Organization
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2700
Mailing address
PO BOX 3206, IDAHO FALLS, ID 83403-3206
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK8249
RAILROAD MEDICARE
—
Enumeration date
11/03/2006
Last updated
03/07/2008
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