Organization
INDEPENDENT ANESTHESIA, PA
Active
Organization
INDEPENDENT ANESTHESIA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE CROFT (BILLING OFFICE MANAGER)
(208) 525-2090
Entity
Organization
Contact information
Practice address
1400 W BANNOCK ST, BOISE, ID 83702-5233
(208) 378-9295
Mailing address
1601 E 17TH ST, IDAHO FALLS, ID 83404-6313
(208) 525-2090
(208) 525-2662
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-246
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A0454
BLUE CROSS
ID
Enumeration date
02/14/2007
Last updated
08/22/2020
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