Provider Demographics
NPI:1891918983
Name:ANESTHESIA ASSOCIATES OF POCATELLO, PA
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF POCATELLO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPMA
Authorized Official - Phone:208-232-7760
Mailing Address - Street 1:PO BOX 4107
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4107
Mailing Address - Country:US
Mailing Address - Phone:208-232-7760
Mailing Address - Fax:208-232-1950
Practice Address - Street 1:333 N 18TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-233-8880
Practice Address - Fax:208-232-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002797500Medicaid
IDCD5673OtherRAILROAD MEDICARE GROUP PTAN
ID002797400Medicaid
ID1374804Medicare ID - Type UnspecifiedMD
ID002797500Medicaid