Provider Demographics
NPI:1376391581
Name:KNOPP ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:KNOPP ANESTHESIA SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-212-1803
Mailing Address - Street 1:12284 E NUNN RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-9310
Mailing Address - Country:US
Mailing Address - Phone:605-212-1803
Mailing Address - Fax:
Practice Address - Street 1:30544 HIGHWAY 200 STE 201
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-5005
Practice Address - Country:US
Practice Address - Phone:208-265-8194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-11
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty