Organization
INTERMOUNTAIN ANESTHESIA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY TAYLOR (CRNA)
(866) 487-0277
Entity
Organization
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6269
Mailing address
PO BOX 94289, MS 631130, SEATTLE, WA 98124-6589
(866) 487-0277
(770) 701-6674
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002712600
—
ID
Enumeration date
06/13/2006
Last updated
07/23/2019
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