Healthcare Provider Details

I. General information

NPI: 1689990871
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA OF NORTHWEST INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GLENDALE BLVD SUITE 102
VALPARAISO IN
46383-3767
US

IV. Provider business mailing address

7 PARKWAY CTR SUITE 375
PITTSBURGH PA
15220-3704
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-6144
  • Fax: 770-237-1492
Mailing address:
  • Phone: 412-937-5947
  • Fax: 770-237-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN J MURPHY
Title or Position: PRESIDENT
Credential: MD
Phone: 412-937-5947