Healthcare Provider Details

I. General information

NPI: 1932306883
Provider Name (Legal Business Name): INDEPENDENT ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14395 HWY 75
MAYETTA KS
66509
US

IV. Provider business mailing address

14395 HWY 75
MAYETTA KS
66509
US

V. Phone/Fax

Practice location:
  • Phone: 785-966-3138
  • Fax: 785-966-3138
Mailing address:
  • Phone: 785-966-3138
  • Fax: 785-966-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54661
License Number StateKS

VIII. Authorized Official

Name: MS. LOU ANN CLOUSE
Title or Position: PRESIDENT
Credential: CRNA
Phone: 785-966-3138