Organization
MOOSE CREEK ANESTHESIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA TEGAN (CREDENTIALING & BILLING)
(208) 734-7362
Entity
Organization
Contact information
Practice address
3925 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
(208) 201-4973
Mailing address
5341 TILDY LN, IDAHO FALLS, ID 83401-6038
(208) 734-7362
(208) 733-9463
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
07/15/2025
Last updated
11/06/2025
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