1629211057 NPI number — MIDWEST ANESTHESIA CORPORATION

Table of content: (NPI 1629211057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629211057 NPI number — MIDWEST ANESTHESIA CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST ANESTHESIA CORPORATION
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:
1629211057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2009
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 0488
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:
04/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GRESS
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/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: 1629211057 . This is a "MIDWEST ANESTHESIA CORPORATION GROUP NPI #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 261140 . This is a "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 28080901 . This is a "CRNA MEDICAL LICENSE #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1982636536 . This is a "PERSONAL NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com