MEDICARE: TIVA OBA, L.L.C.

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	3005577	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1740543990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIVA OBA, L.L.C.

Provider Business Mailing Address
First Line	:	4729 RAZOR CREEK WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-5533
Country	:	US
Telephone Number	:	502-797-1567
Fax Number	:	502-713-1979

Provider Business Practice Location Address
First Line	:	4729 RAZOR CREEK WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-5533
Country	:	US
Telephone Number	:	502-797-1567
Fax Number	:	502-713-1979

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER PAUL BOWEN
Credential	:	CRNA, APRN
Telephone Number	:	502-797-1567

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	06/22/2012

Similar Medicare Providers

1881526952 — BEYOND BEAUTY PRIMARY CARE & WELLNESS
Practice Location Address:

11704 WASHINGTON GREEN RD
LOUISVILLE, KY
40229-5533

Practice Phone: 502-544-4047
Practice Fax: 502-544-4047

1477587293 — KROGER LIMITED PARTNERSHIP I
Practice Location Address:

5533 NEW CUT RD
LOUISVILLE, KY
40214-4329

Practice Phone: 502-361-7238
Practice Fax: 502-361-7129

1689938532 — DR. SHANTEL DEANNA CROSBY PHD, LCSW
Practice Location Address:

11700 WASHINGTON GREEN RD
LOUISVILLE, KY
40229-5533

Practice Phone: 502-208-8496
Practice Fax:

1700209764 — KIOSK MEDICINE KENTUCKY LLC
Practice Location Address:

5533 NEW CUT RD
LOUISVILLE, KY
40214-4329

Practice Phone: 502-364-2770
Practice Fax: 502-364-2771

1477951168 — MRS. ASHLEY NICOLE MCCAULEY APRN, FNP-BC
Practice Location Address:

5533 NEW CUT RD
LOUISVILLE, KY
40214

Practice Phone: 502-364-2770
Practice Fax: 502-364-2771

1801409883 — CHRISTIE LYNN RALEIGH
Practice Location Address:

5533 NEW CUT RD
LOUISVILLE, KY
40214-4329

Practice Phone: 502-361-5943
Practice Fax: 502-361-7129

Directions to “TIVA OBA, L.L.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.