MEDICARE: NORTHERN INDIANA ANESTHESIA ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1033891510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN INDIANA ANESTHESIA ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 737897
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-7897
Country	:	US
Telephone Number	:	888-717-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	53830 GENERATIONS DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1557
Country	:	US
Telephone Number	:	574-217-0174
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JEFF PERRY
Credential	:
Telephone Number	:	502-418-4700

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	07/23/2025

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