1356414197 NPI number — RELIABLE ANESTHEZIA AND PAIN MANAGEMENT SERVICES PSC

Table of content: (NPI 1356414197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356414197 NPI number — RELIABLE ANESTHEZIA AND PAIN MANAGEMENT SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE ANESTHEZIA AND PAIN MANAGEMENT SERVICES PSC
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:
1356414197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 501063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46250-6063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-258-2873
Provider Business Mailing Address Fax Number:
866-588-8131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2209 JOHN R WOODEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46151-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-342-8441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BONHAM
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
317-258-2873

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  01062928A , 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: 1073566097 . This is a "CMUNDELIUS NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1205984366 . This is a "SKRISTIANSEN NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1598825762 . This is a "MARANT NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1780602094 . This is a "TRENT MILLER MD NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1285743310 . This is a "ROESTERLING NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1912992124 . This is a "DWHITAKER NPI#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".