Healthcare Provider Details

I. General information

NPI: 1851227144
Provider Name (Legal Business Name): MATTHEW O'NEAL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SYCAMORE CT STE 1B
COLUMBUS IN
47203-1545
US

IV. Provider business mailing address

3437 ROYAL OAK DR
INDIANAPOLIS IN
46227-7074
US

V. Phone/Fax

Practice location:
  • Phone: 812-378-9027
  • Fax: 812-378-1014
Mailing address:
  • Phone: 317-490-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28223803A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: