Organization
GLACIER ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP C BLUM MD (PRESIDENT)
(208) 525-2090
Entity
Organization
Contact information
Practice address
150 BUFFALO WAY, JACKSON, WY 83002
(307) 733-8677
Mailing address
1601 E 17TH ST, IDAHO FALLS, ID 83404-6313
(208) 525-2090
(208) 525-2662
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/20/2006
Last updated
09/11/2025
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