Provider Demographics
NPI:1114119955
Name:ORTHOPEDIC AMBULATORY ANESTHESIA PA
Entity Type:Organization
Organization Name:ORTHOPEDIC AMBULATORY ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:HALDIS
Authorized Official - Last Name:KASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-939-4704
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-0904
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:503-372-2755
Practice Address - Street 1:1425 W RIVER ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6861
Practice Address - Country:US
Practice Address - Phone:208-342-1932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806281000Medicaid
ID8F504OtherBLUE CROSS
ID8F504OtherBLUE CROSS