Healthcare Provider Details

I. General information

NPI: 1043276553
Provider Name (Legal Business Name): PREMIER ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

PO BOX 408
GREENSBURG IN
47240-0408
US

V. Phone/Fax

Practice location:
  • Phone: 812-569-0421
  • Fax:
Mailing address:
  • Phone: 812-569-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JIM P DOYLE
Title or Position: CO-OWNER
Credential: CRNA
Phone: 812-569-0421