Healthcare Provider Details

I. General information

NPI: 1285382010
Provider Name (Legal Business Name): SALT CITY ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N WALDRON ST STE 2
HUTCHINSON KS
67502-1176
US

IV. Provider business mailing address

14 OAKWOOD LN
HUTCHINSON KS
67502-1800
US

V. Phone/Fax

Practice location:
  • Phone: 620-833-0960
  • Fax: 833-615-2260
Mailing address:
  • Phone: 316-518-1726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN J FLEEMAN
Title or Position: PRESIDENT
Credential: DNAP
Phone: 316-518-1726