Provider Demographics
NPI:1033147467
Name:ANESTHESIA ASSOCIATES OF BOISE, P.A.
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF BOISE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-336-0895
Mailing Address - Street 1:338 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6207
Mailing Address - Country:US
Mailing Address - Phone:208-336-0895
Mailing Address - Fax:208-338-1796
Practice Address - Street 1:338 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6207
Practice Address - Country:US
Practice Address - Phone:208-336-0895
Practice Address - Fax:208-338-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002359600Medicaid
ID002358300Medicaid
ID002358300Medicaid
ID1373909Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER-MD