Organization
JSC ANESTHESIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CARMICHAEL CRNA (OWNER)
(208) 525-2090
Entity
Organization
Contact information
Practice address
1601 E 17TH ST, IDAHO FALLS, ID 83404-6313
(208) 525-2090
(208) 525-2662
Mailing address
650 ADDISON AVE W, TWIN FALLS, ID 83301-5444
(208) 525-2090
(208) 525-2662
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
N22808
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8K776
BLUE CROSS OF IDAHO
ID
Enumeration date
05/02/2007
Last updated
08/22/2020
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