AMBULATORY SURGERY CENTER OF BURLEY ANESTHESIA
NPI 1780103507
Nurse Anesthetist, Certified Registered in Burley, ID
NPI Status: Active since September 13, 2017
Contact Information
1344 HILAND AVE STE E
BURLEY, ID
ZIP 83318
Phone: (208) 677-8888
Fax: (208) 678-5833
- Organization
- Nurse Anesthetist, Certified Registered
- CLIA Number: 13D0969156
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 01-04-2028
About AMBULATORY SURGERY CENTER OF BURLEY ANESTHESIA
This page provides the complete NPI Profile along with additional information for Ambulatory Surgery Center Of Burley Anesthesia, a provider established in Burley, Idaho operating as a Nurse Anesthetist, Certified Registered. The healthcare provider is registered in the NPI registry with number 1780103507 assigned on September 2017. The practitioner's primary taxonomy code is 367500000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's other name is Ambulatory Surgery Center Of Burley Anesthesia. The authorized official of this NPI record is Joseph R Petersen Md (Ceo)
- NPI
- 1780103507
- Provider Legal Name
- AMBULATORY SURGERY CENTER OF BURLEY, LLC
- Other Organization Name
- AMBULATORY SURGERY CENTER OF BURLEY ANESTHESIA
- Other Name Type
- Other Name (5)
- Entity Type
- Organization
- Location Address
- 1344 HILAND AVE STE E BURLEY, ID 83318
- Location Phone
- (208) 677-8888
- Location Fax
- (208) 678-5833
- Mailing Address
- 1344 HILAND AVE STE E BURLEY, ID 83318
- Mailing Phone
- (208) 677-8888
- Mailing Fax
- (208) 678-5833
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 09-13-2017
- Last Update Date
- 07-21-2022
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Anesthetist, Certified Registered
- Taxonomy Code
- 367500000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- Taxonomy Description
- (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.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D0969156
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- January 05, 2026
- Certificate Expiration Date
- January 04, 2028
- Laboratory Director
- CINDY MANGUM
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Ambulatory Surgery Center Of Burley Anesthesia to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1780103507, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
BURLEY, ID 83318
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1780103507, enumerated as an "organization" on September 13, 2017.
The provider is located at 1344 HILAND AVE STE E BURLEY, ID 83318 and the phone number is (208) 677-8888.
Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
