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NPI Code Detail

MEDICARE: JADA ANESTHESIA LLC

MEDICARE: JADA 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
1367500000XCertified Registered Nurse AnesthetistRN438627OH

General Provider Information

NPI Number : 1528597770
Entity Type Code : Organization
Provider Name (Legal Business Name) : JADA ANESTHESIA LLC
Provider Business Mailing Address
First Line : PO BOX 1296
Second Line :
City : WARSAW
State : IN
Zip : 46581-1296
Country : US
Telephone Number : 574-268-9640
Fax Number : 574-268-0684
Provider Business Practice Location Address
First Line : 3509 BRIARFIELD BLVD
Second Line :
City : MAUMEE
State : OH
Zip : 43537-9383
Country : US
Telephone Number : 419-865-3866
Fax Number : 574-268-0684
Authorized Official
Title or Position : OFFICE MANAGER
Name : LINDA CROOKS
Credential :
Telephone Number : 574-268-9640
Provider Enumeration Date : 06/09/2017
Last Update Date : 06/09/2017

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