Healthcare Provider Details

I. General information

NPI: 1962823294
Provider Name (Legal Business Name): CHAD RICHARD CONTRI CRNA, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 W HOSPITAL RD
PAOLI IN
47454-9672
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-7453
  • Fax: 812-723-7500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28154687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: