Healthcare Provider Details

I. General information

NPI: 1477899904
Provider Name (Legal Business Name): SCP ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 N SHADELAND AVE STE 100
INDIANAPOLIS IN
46250-2070
US

IV. Provider business mailing address

7430 N SHADELAND AVE STE 100
INDIANAPOLIS IN
46250-2070
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-8005
  • Fax: 317-841-8092
Mailing address:
  • Phone: 317-841-8005
  • Fax: 317-841-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID W HOLST
Title or Position: PRESIDENT BOARD OF MANAGERS
Credential:
Phone: 615-345-6900