Provider Demographics
NPI:1952141418
Name:BOISE VALLEY ANESTHESIA LLC
Entity type:Organization
Organization Name:BOISE VALLEY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOCHAY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:208-794-1559
Mailing Address - Street 1:PO BOX 2291
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2291
Mailing Address - Country:US
Mailing Address - Phone:800-338-5378
Mailing Address - Fax:208-523-8978
Practice Address - Street 1:1828 S MILLENIUM WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5036
Practice Address - Country:US
Practice Address - Phone:208-381-0262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty