MEDICARE: INDEPENDENT ANESTHESIOLOGISTS, PSC

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	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000032124	OTHER	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538330204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT ANESTHESIOLOGISTS, PSC

Provider Business Mailing Address
First Line	:	PO BOX 12749
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41012-0749
Country	:	US
Telephone Number	:	859-341-7246
Fax Number	:	859-341-7867

Provider Business Practice Location Address
First Line	:	7520 STATE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-2439
Country	:	US
Telephone Number	:	859-341-7246
Fax Number	:	859-341-7867

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD PARK
Credential	:
Telephone Number	:	859-341-7246

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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