Healthcare Provider Details

I. General information

NPI: 1255492682
Provider Name (Legal Business Name): ANESTHESIOLOGY OF PADUCAH, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KENTUCKY AVENUE WESTERN BAPTIST HOSPITAL
PADUCAH KY
42003
US

IV. Provider business mailing address

2507 BROADWAY
PADUCAH KY
42001-3124
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-2100
  • Fax:
Mailing address:
  • Phone: 270-442-8228
  • Fax: 270-442-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DIANA L FREEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-442-8228