Healthcare Provider Details

I. General information

NPI: 1568416295
Provider Name (Legal Business Name): ANESTHESIOLOGIST GROUP OF HENRY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N 16TH ST
NEW CASTLE IN
47362-4319
US

IV. Provider business mailing address

2001 N GRANVILLE AVE
MUNCIE IN
47303-2110
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-0890
  • Fax: 765-521-1353
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: MERRILL I MOREY
Title or Position: PARTNER
Credential: MD
Phone: 765-521-0890