Healthcare Provider Details

I. General information

NPI: 1174541981
Provider Name (Legal Business Name): NEWBURGH ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 GLENSTONE CT
NEWBURGH IN
47630-8074
US

IV. Provider business mailing address

2177 GLENSTONE CT PO BOX 1225
NEWBURGH IN
47630-8074
US

V. Phone/Fax

Practice location:
  • Phone: 812-490-3420
  • Fax: 812-634-7152
Mailing address:
  • Phone: 812-490-3420
  • Fax: 812-634-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28151018A
License Number StateIN

VIII. Authorized Official

Name: CATHY ANN LEAKE ROGERS
Title or Position: CRNA
Credential: CRNA
Phone: 812-490-3420