Ambulatory Surgery Center of Burley, LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

AMBULATORY SURGERY CENTER OF BURLEY, LLC

Practice address

1344 Hiland Ave Ste E
Burley, ID 83318-1564

Phone

(208) 677-8888

Fax

(208) 678-5833

NPI assigned

Sep 13, 2017

Organization subpart

Yes

Parent organization

AMBULATORY SURGERY CENTER OF BURLEY, LLCAs reported in NPPES

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

Authorized official

Name

Joseph R Petersen, MD

Title

Ceo

Phone

(208) 677-8888

Specialties & licenses 1

Addresses

Other names 1

• Ambulatory Surgery Center of Burley Anesthesia Other name

Tax ID family

Ambulatory Surgery Cent2 organizations share this tax ID, including this one

Part of

Ambulatory Surgery Cent

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ambulatory Surgery Center of Burley, LLC

  • Ambulatory Surgical Clinic/Center
  • Burley, ID
  • NPI 1992706840
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Ambulatory Surgery Center of Burley, LLC

  • Ambulatory Surgical Clinic/Center
  • Burley, ID
  • NPI 1992706840
  NPPES parent name

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780103507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 HILAND AVE STE E",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833181564",
            "telephone_number": "208-677-8888",
            "fax_number": "208-678-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 HILAND AVE STE E",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833181564",
            "telephone_number": "208-677-8888",
            "fax_number": "208-678-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBULATORY SURGERY CENTER OF BURLEY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMBULATORY SURGERY CENTER OF BURLEY, LLC",
        "enumeration_date": "2017-09-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-677-8888",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ambulatory Surgery Center of Burley Anesthesia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Burley, ID
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.