Provider Demographics
NPI:1013571801
Name:SISC ANESTHESIA INC
Entity Type:Organization
Organization Name:SISC ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JEANETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-895-1908
Mailing Address - Street 1:3235 N TOWERBRIDGE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5721
Mailing Address - Country:US
Mailing Address - Phone:208-895-1908
Mailing Address - Fax:208-895-1908
Practice Address - Street 1:3235 N TOWERBRIDGE WAY STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5721
Practice Address - Country:US
Practice Address - Phone:208-895-1908
Practice Address - Fax:208-895-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty