1215015771 NPI number — GRESS ANESTHESIA SERVICES, PC

Table of content: (NPI 1215015771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215015771 NPI number — GRESS ANESTHESIA SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRESS ANESTHESIA SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215015771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 3RD AVE
Provider Second Line Business Mailing Address:
PO BOX 488
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47546-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-482-9617
Provider Business Mailing Address Fax Number:
812-634-7152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47546-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-482-9617
Provider Business Practice Location Address Fax Number:
812-634-7152
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRESS
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-482-9617

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  28080901 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200055770 . This is a "DAVIESS COUNTY HOSPITAL MEDICAID #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00116059 . This is a "DAVIESS COUNTY HOSPITAL MEDICARE R/R #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200318250A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982636536 . This is a "CYNTHIA D GRESS PERSONAL PROVIDER NPI #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: CB2060D . This is a "DAVIESS COUNTY HOSPITAL MEDICARE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com