1194700245 NPI number — MARION WAYNE KISER CRNA

Table of content: MARION WAYNE KISER CRNA (NPI 1194700245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194700245 NPI number — MARION WAYNE KISER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KISER
Provider First Name:
MARION
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1194700245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MEDICAL VILLAGE DRIVE
Provider Second Line Business Mailing Address:
SUITE 258 MILLENIUM ANESTHESIA LLC
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-7246
Provider Business Mailing Address Fax Number:
859-341-7867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 STATE ROAD
Provider Second Line Business Practice Location Address:
ANESTHESIA INTENSIVE CARE CONSULTANTS INC
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7246
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  167349 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 728027 . This is a "BUCKEYE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74005315 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000277554 . This is a "ANTHEM BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200381120 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2091196 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 617582 . This is a "WELLCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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