Healthcare Provider Details

I. General information

NPI: 1326126681
Provider Name (Legal Business Name): GREATER LOUISVILLE ANESTHESIA SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 NEW MOODY LN C/O BAPTIST HOSPITAL NORTHEAST
LAGRANGE KY
40031-9154
US

IV. Provider business mailing address

1025 NEW MOODY LN
LAGRANGE KY
40031-9154
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-3886
  • Fax: 502-222-8647
Mailing address:
  • Phone: 502-222-3886
  • Fax: 502-222-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25877
License Number StateKY

VIII. Authorized Official

Name: MS. KAREN BUTTERFIELD
Title or Position: MGR/OWNER
Credential: CRNA
Phone: 502-222-3886