Healthcare Provider Details

I. General information

NPI: 1972744126
Provider Name (Legal Business Name): NEWBURGH ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W IOWA ST
EVANSVILLE IN
47710-1721
US

IV. Provider business mailing address

PO BOX 2626
FORT WORTH TX
76113-2626
US

V. Phone/Fax

Practice location:
  • Phone: 812-435-1600
  • Fax:
Mailing address:
  • Phone: 817-294-7444
  • Fax: 817-294-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28151018A
License Number StateIN

VIII. Authorized Official

Name: CATHY A ROGERS
Title or Position: CRNA
Credential: CRNA
Phone: 817-294-7444