Healthcare Provider Details

I. General information

NPI: 1548442650
Provider Name (Legal Business Name): LOUISVILLE ANESTHESIA PROVISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 MIDDLE RD
COLUMBUS IN
47203-4472
US

IV. Provider business mailing address

PO BOX 1044
DALTON GA
30722-1044
US

V. Phone/Fax

Practice location:
  • Phone: 502-693-5421
  • Fax:
Mailing address:
  • Phone: 502-693-5421
  • Fax:

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: KYLE J GOLDSMITH
Title or Position: CRNA
Credential:
Phone: 502-693-5421