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NPI Code Detail

MEDICARE: RIVER BEND ANESTHESIA, LLC

MEDICARE: RIVER BEND ANESTHESIA, 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
1207L00000XAnesthesiology Physician01038482IN

General Provider Information

NPI Number : 1043291693
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER BEND ANESTHESIA, LLC
Provider Business Mailing Address
First Line : PO BOX 68952
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-0952
Country : US
Telephone Number : 317-802-6321
Fax Number : 317-870-0499
Provider Business Practice Location Address
First Line : 215 W 4TH ST
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-1917
Country : US
Telephone Number : 574-271-0013
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BRAD RICHARDS
Credential : MD
Telephone Number : 574-271-0013
Provider Enumeration Date : 11/10/2005
Last Update Date : 10/24/2007

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Directions to “RIVER BEND ANESTHESIA, LLC ” Practice Location

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