Healthcare Provider Details

I. General information

NPI: 1568444693
Provider Name (Legal Business Name): NORTHSIDE ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

PO BOX 7232 DEPT 165
INDIANAPOLIS IN
46207-7232
US

V. Phone/Fax

Practice location:
  • Phone: 317-567-2180
  • Fax: 317-567-2180
Mailing address:
  • Phone: 317-567-2180
  • Fax: 317-567-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: ANDREW SATZ
Title or Position: HEAD MANAGING MEMBER
Credential: MD
Phone: 317-567-2180