Provider Demographics
NPI:1093703340
Name:ANESTHESIOLOGY CONSULTANTS OF IDAHO PA
Entity Type:Organization
Organization Name:ANESTHESIOLOGY CONSULTANTS OF IDAHO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-463-5029
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 250E
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:866-263-1223
Mailing Address - Fax:509-835-4058
Practice Address - Street 1:1512 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6008
Practice Address - Country:US
Practice Address - Phone:208-463-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC122890207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0207Medicaid
ID8052399Medicaid
ID805239900Medicaid
ID8082399Medicaid
ID8082399Medicaid
ID1375339Medicare PIN
IDCN7288Medicare ID - Type UnspecifiedRAILROAD
ID1375339Medicare ID - Type Unspecified