NPIMap

Organization Active NPI

Overton-Stiff Professional Anesthesia Service LTD

  • Certified Registered Nurse Anesthetist
  • Boise, ID
National Provider Identifier
1417065152
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
N25778 Issued in ID
Legal business name
OVERTON-STIFF PROFESSIONAL ANESTHESIA SERVICE LTD
Practice address
6302 Talcrest
Boise, ID 83713-1207
Phone
(208) 939-3255
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marguerite Overton, CRNA
Title
President
Phone
(208) 939-3255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X N25778 ID Primary

Addresses

Primary practice location

6302 Talcrest
Boise, ID 83713-1207

Mailing address

PO Box 2203
Idaho Falls, ID 83403-2203
Phone (208) 525-2090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000827 OR Part B Supplier - Clinic/Group Practice 6901793975 Practice locations: Ontario, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1417065152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2203",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834032203",
            "telephone_number": "208-525-2090",
            "fax_number": "208-523-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6302 TALCREST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131207",
            "telephone_number": "208-939-3255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVERTON-STIFF PROFESSIONAL ANESTHESIA SERVICE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "OVERTON",
        "authorized_official_first_name": "MARGUERITE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-939-3255",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "N25778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.