Provider Demographics
NPI:1962440966
Name:ANESTHESIA ASSOCIATES OF COEUR D ALENE PLLC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF COEUR D ALENE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-771-3722
Mailing Address - Street 1:PO BOX 35145 #40023
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5145
Mailing Address - Country:US
Mailing Address - Phone:425-407-1500
Mailing Address - Fax:425-407-1112
Practice Address - Street 1:101 W IRONWOOD DR STE 250
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1415
Practice Address - Country:US
Practice Address - Phone:208-765-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010017887OtherREGENCE B/S GROUP NUMBER
IDCE9560OtherRR MEDICARE GRP NUMBER
ID8B016OtherBLUE CROSS IDAHO GROUP #
ID1602900Medicare PIN
ID8B016OtherBLUE CROSS IDAHO GROUP #