Healthcare Provider Details

I. General information

NPI: 1780616375
Provider Name (Legal Business Name): GRESS ANESTHESIA SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 1/2 MAIN ST
JASPER IN
47546-3132
US

IV. Provider business mailing address

510 1/2 MAIN ST
JASPER IN
47546-3132
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-9617
  • Fax: 812-634-7152
Mailing address:
  • Phone: 812-482-9617
  • Fax: 812-634-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55000034A
License Number StateIN

VIII. Authorized Official

Name: CYNTHIA DIANE GRESS
Title or Position: PRESIDENT
Credential: CRNA
Phone: 812-482-9617