Healthcare Provider Details

I. General information

NPI: 1477507689
Provider Name (Legal Business Name): PIONEER ANESTHESIA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HADLEY RD
MOORESVILLE IN
46158-1737
US

IV. Provider business mailing address

2001 N GRANVILLE AVE
MUNCIE IN
47303-2110
US

V. Phone/Fax

Practice location:
  • Phone: 317-831-1160
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-213-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGG A IMEL
Title or Position: PARTNER
Credential: MD
Phone: 317-831-1160