Healthcare Provider Details

I. General information

NPI: 1093022774
Provider Name (Legal Business Name): HEARTLAND ANESTHESIA CONSULTANT, P.S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 NORTH MULBERRY STREET
ELIZABETHTOWN KY
42701-1931
US

IV. Provider business mailing address

639 NORTH MULBERRY STREET
ELIZABETHTOWN KY
42701-1931
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-4600
  • Fax: 270-737-1722
Mailing address:
  • Phone: 270-737-4600
  • Fax: 270-737-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateKY

VIII. Authorized Official

Name: SANDY SPALDING
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-737-4600