Organization
INNOVATIVE ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE DEMKO (PARTNER)
(208) 265-3534
Entity
Organization
Contact information
Practice address
30544 HIGHWAY 200 STE 201, PEND OREILLE SURGERY CENTER, PONDERAY, ID 83852-5005
(208) 265-8194
Mailing address
PO BOX 591, SAGLE, ID 83860-0591
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-491A
ID
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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