Provider Demographics
NPI:1275251456
Name:DREAMTIME ANESTHESIA LLC
Entity Type:Organization
Organization Name:DREAMTIME ANESTHESIA LLC
Other - Org Name:DREAMTIME ANESTHESIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SPARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:509-847-9835
Mailing Address - Street 1:PO BOX 3545
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403
Mailing Address - Country:US
Mailing Address - Phone:208-525-2090
Mailing Address - Fax:208-523-8978
Practice Address - Street 1:1424 N MCDONALD RD #101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-928-7272
Practice Address - Fax:509-928-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60215327Medicaid