Organization
INLAND ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT SMITH (DELEGATED OFFICIAL)
(208) 882-7530
Entity
Organization
Contact information
Practice address
2300 W A ST, MOSCOW, ID 83843-4038
(208) 882-7530
Mailing address
PO BOX 1829, COEUR D ALENE, ID 83816-1829
(208) 667-9334
(208) 664-2341
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A3508
BC ID
ID
01
—
DB9257
RAILROAD MEDICARE
—
Enumeration date
08/31/2005
Last updated
03/27/2008
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