Ambulatory Surgery Center of Burley, LLC
NPI 1780103507ActiveOrganization· Nurse Anesthetist, Certified Registered· Burley, ID
Nurse Anesthetist, Certified Registered in Burley, Idaho, registered in NPPES in September 2017, part of Ambulatory Surgery Center of Burley, LLC. The authorized official on file is Joseph R. Petersen, MD, Ceo.
Overview
| NPI | 1780103507 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Ambulatory Surgery Center of Burley, LLC |
| NPI issued | Sep 13, 2017 |
| Last updated in NPPES | Jul 21, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Anesthetist, Certified Registered Primary | 367500000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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