Provider Demographics
NPI:1609413343
Name:INTERMOUNTAIN ANESTHESIA ASSOCIATES PLLC
Entity Type:Organization
Organization Name:INTERMOUNTAIN ANESTHESIA ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:509-552-6666
Mailing Address - Street 1:PO BOX 84702
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6002
Mailing Address - Country:US
Mailing Address - Phone:877-746-7090
Mailing Address - Fax:
Practice Address - Street 1:318 WARNER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4441
Practice Address - Country:US
Practice Address - Phone:208-298-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty