Provider Demographics
NPI:1871918318
Name:WEST IDAHO ANESTHESIA, LLP
Entity type:Organization
Organization Name:WEST IDAHO ANESTHESIA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WESTOVER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:208-550-1042
Mailing Address - Street 1:PO BOX 3816
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-3816
Mailing Address - Country:US
Mailing Address - Phone:208-552-8572
Mailing Address - Fax:208-523-2025
Practice Address - Street 1:3115 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6972
Practice Address - Country:US
Practice Address - Phone:208-453-8668
Practice Address - Fax:208-523-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty