Healthcare Provider Details

I. General information

NPI: 1447618632
Provider Name (Legal Business Name): ANESTHESIA SERVICES OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HARVEST LN
MOUNT WASHINGTON KY
40047-5814
US

IV. Provider business mailing address

210 HARVEST LN
MOUNT WASHINGTON KY
40047-5814
US

V. Phone/Fax

Practice location:
  • Phone: 502-644-3915
  • Fax:
Mailing address:
  • Phone: 502-644-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3010044
License Number StateKY

VIII. Authorized Official

Name: DR. MUSHTAQUE JUNEJA
Title or Position: PRESIDENT
Credential: MD
Phone: 502-629-2880