Ambulatory Surgery Center Of Burley, LLC
Nurse Anesthetist, Certified Registered in Burley, ID. Organization (NPI-2).
NPI number1780103507
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1780103507
- Entity type
- Organization (NPI-2)
- Legal business name
- Ambulatory Surgery Center Of Burley, LLC
- Organization subpart
- Yes
- Enumeration date
- Sep 13, 2017
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | – | – | Yes |
Other names
- Ambulatory Surgery Center Of Burley Anesthesia (Other Name)
Practice location
1344 Hiland Ave Ste EBurley, ID 83318-1564
Phone 208-677-8888 · Fax 208-678-5833
Mailing address
1344 Hiland Ave Ste EBurley, ID 83318-1564
Phone 208-677-8888 · Fax 208-678-5833
Authorized official
Joseph R Petersen
Ceo
2086778888
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