Healthcare Provider Details

I. General information

NPI: 1083639660
Provider Name (Legal Business Name): NORTHERN INDIANA ANESTHESIA SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514
US

IV. Provider business mailing address

7 PARKWAY CTR STE 375
PITTSBURGH PA
15220
US

V. Phone/Fax

Practice location:
  • Phone: 574-523-3193
  • Fax: 574-523-3464
Mailing address:
  • Phone: 412-937-5700
  • Fax: 412-937-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN S CHUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 574-523-3193