Healthcare Provider Details

I. General information

NPI: 1992988224
Provider Name (Legal Business Name): AMSOL ANESTHETISTS OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 S TIWARI BLVD
BLOOMINGTON IN
47403-8000
US

IV. Provider business mailing address

PO BOX 2644
BIRMINGHAM AL
35202-2644
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-1111
  • Fax:
Mailing address:
  • Phone: 205-322-1808
  • Fax: 205-322-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALAN D HILLIARD
Title or Position: CFO
Credential:
Phone: 336-884-1830