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NPI Code Detail

MEDICARE: PORTER COUNTY ANESTHESIA ASSOCIATES PC

MEDICARE: PORTER COUNTY ANESTHESIA ASSOCIATES PC
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 Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DA4395OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215974936
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTER COUNTY ANESTHESIA ASSOCIATES PC
Provider Business Mailing Address
First Line : PO BOX 10806
Second Line :
City : MERRILLVILLE
State : IN
Zip : 46411-0806
Country : US
Telephone Number : 219-983-5743
Fax Number : 219-983-5994
Provider Business Practice Location Address
First Line : 85 E US HIGHWAY 6
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-8947
Country : US
Telephone Number : 219-983-5743
Fax Number : 219-983-5994
Authorized Official
Title or Position : PRESIDENT
Name : DR. RAJA RAVELLA
Credential : M.D.
Telephone Number : 219-983-5743
Provider Enumeration Date : 06/01/2006
Last Update Date : 03/18/2013

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Directions to “PORTER COUNTY ANESTHESIA ASSOCIATES PC ” Practice Location

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