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AMBULATORY SURGERY CENTER OF BURLEY ANESTHESIA
NPI 1780103507
Nurse Anesthetist, Certified Registered in Burley, ID

Active since September 13, 2017CLIA 13D0969156 · Waiver
1344 HILAND AVE STE E, BURLEY, ID 83318(208) 677-8888(208) 678-5833 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 21, 2022, Sep 13, 2017 (2 updates tracked since 2017).

About Ambulatory Surgery Center Of Burley Anesthesia NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMBULATORY SURGERY CENTER OF BURLEY ANESTHESIA (NPI 1780103507) is a healthcare organization registered as a nurse anesthetist, certified registered in Burley, Idaho and active in the NPI registry since September 2017. The organization holds a CLIA Waiver certificate valid through January 4, 2028 and lists Joseph R Petersen, Ceo, as its authorized official.

NPPES Registry Identity

NPI1780103507
Entity TypeOrganization
Primary Taxonomy367500000X
Legal Business NameAMBULATORY SURGERY CENTER OF BURLEY, LLC
Location Address1344 HILAND AVE STE EBurley, ID 83318-1564
Mailing Address1344 Hiland Ave Ste EBurley, ID 83318-1564 · (208) 677-8888 · Fax (208) 678-5833
Phone(208) 677-8888
Fax(208) 678-5833
Organization SubpartYes
Authorized OfficialJoseph R PetersenCeo · (208) 677-8888
Enumeration DateSeptember 13, 2017
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1780103507 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
1344 HILAND AVE STE E, Burley, ID 83318
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Other Names 1

Other NameAmbulatory Surgery Center Of Burley Anesthesia

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D0969156

Ambulatory Surgery Center Of Burley · Burley, ID
Active · expires Jan 4, 2028
CLIA Number13D0969156
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateJanuary 5, 2026
Certificate Expiration DateJanuary 4, 2028
Laboratory DirectorCindy Mangum
Laboratory Phone(208) 677-8888
Laboratory LocationAmbulatory Surgery Center Of Burley1344 Hiland Ave, Ste E, Burley, ID 83318
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROFESSIONAL ANESTHESIA SERVICES
Nurse Anesthetist, Certified Registered
1344 HILAND AVE STE E
BURLEY, ID 83318
Cassia County (208) 677-8888

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ambulatory Surgery Center Of Burley, LLC's NPI number?

The NPI number for Ambulatory Surgery Center Of Burley, LLC is 1780103507. It was assigned to this organization in the NPPES registry on September 13, 2017. The provider is also known as Ambulatory Surgery Center Of Burley Anesthesia.

Where is Ambulatory Surgery Center Of Burley, LLC located?

Ambulatory Surgery Center Of Burley, LLC is located at 1344 Hiland Ave Ste E, Burley, ID 83318. The listed phone number is (208) 677-8888.

What is Ambulatory Surgery Center Of Burley, LLC's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Does Ambulatory Surgery Center Of Burley, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D0969156) is associated with this NPI, valid through January 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ambulatory Surgery Center Of Burley, LLC was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.