| Mr Walter Jesse Trudo, CRNA | |
| 
					3100 Channing Way, Idaho Falls, ID 83404-7533  | |
| (479) 659-2746 | |
| Not Available | 
| Full Name | Mr Walter Jesse Trudo | 
|---|---|
| Gender | Male | 
| Speciality | Nurse Anesthetist, Certified Registered | 
| Location | 3100 Channing Way, Idaho Falls, Idaho | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1841243474 | NPI | - | NPPES | 
| 4704251198 | Other | MI | ANESTHESIOLOGY | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | R 0090514 (Oklahoma) | Primary | 
| Entity Name | Taylor Surgery Center, Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1740738897 PECOS PAC ID: 2163601675 Enrollment ID: O20110128000551  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Mr Walter Jesse Trudo, CRNA 343 Sunterra Dr, Idaho Falls, ID 83404-5089 Ph: (479) 659-2746  | Mr Walter Jesse Trudo, CRNA 3100 Channing Way, Idaho Falls, ID 83404-7533 Ph: (479) 659-2746  | 
Reed D Loertscher, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6285  | |
Mr. David Joseph Swope, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 2290 Coronado St, Idaho Falls, ID 83404 Phone: 208-421-1159  | |
Jason Cole Semchak, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6111  | |
Carlene M Canfield, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1601 E 17th St, Idaho Falls, ID 83404 Phone: 208-525-2090 Fax: 208-525-2662  | |
Douglas Jex, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 208-529-6269  | |
Mr. Bryan Todd Merkley, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 2325 Coronado St, Idaho Falls, ID 83404 Phone: 208-557-2700  | |
Dr. Scott Havard, DNP, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 2325 Coronado St, Idaho Falls, ID 83404 Phone: 207-745-4081  |