NPI age
20 years
Enumerated 2005-08-02
● Active Type 2 · Organization
Ambulatory Surgery Center Of Burley, Llc
Ambulatory Surgery Center Of Burley, Llc is 1 of 99 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Petersen
Ceo
Last NPPES update
2017-08-17
Source: monthly bulk 2026-05
How this organization compares
Across 99 active clinic/center providers in Idaho.
NPI age
20 years
↑ 2 yr above median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 11% of peers with subspecialties
NPI lifetime · 2005 → 2026
2005-08Enumerated in NPPES
2005
2026
Where they practice
Primary practice location
1344 Hiland Ave, Suite E
Burley, ID 833181564
Mailing address
1344 Hiland Ave, Suite E
Burley, ID 833181564
Authorized official
Joseph R. Petersen, M.D.
Ceo
📞 2086778888
Specialties
-
Clinic/Center PrimaryDefinition to come...
-
Nurse Anesthetist, Certified Registered(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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 805534000 | |
| 01 (ID) | 24973 000010005417 | BLUE SHIELD |
| 01 (ID) | 03822 | BLUE CROSS |
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.