Provider Demographics
NPI:1184046971
Name:GIBB ANESTHESIA
Entity type:Organization
Organization Name:GIBB ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:208-552-8571
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2123
Mailing Address - Country:US
Mailing Address - Phone:208-552-8571
Mailing Address - Fax:208-523-2025
Practice Address - Street 1:478 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-3202
Practice Address - Country:US
Practice Address - Phone:541-881-1794
Practice Address - Fax:541-889-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty