1164701447 NPI number — MURRAY ANESTHETISTS GROUP, PLLC

Table of content: MISS ROSA ISELA PENA LD (NPI 1730386277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164701447 NPI number — MURRAY ANESTHETISTS GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MURRAY ANESTHETISTS GROUP, PLLC
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:
1164701447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 N 12TH ST # 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42071-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-748-6851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 POPLAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-762-1100
Provider Business Practice Location Address Fax Number:
270-762-1586
Provider Enumeration Date:
08/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
270-748-6851

Provider Taxonomy Codes

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

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





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