Healthcare Provider Details

I. General information

NPI: 1598746133
Provider Name (Legal Business Name): HANCOCK ANESTHESIA GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

PO BOX 68952
INDIANAPOLIS IN
46268-0952
US

V. Phone/Fax

Practice location:
  • Phone: 317-871-8261
  • Fax: 317-870-0499
Mailing address:
  • Phone: 317-871-8261
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAIR T. STOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 317-871-8261