Healthcare Provider Details

I. General information

NPI: 1164600151
Provider Name (Legal Business Name): SHIAWASSEE ANESTHESIA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

PO BOX 115
SWARTZ CREEK MI
48473-0115
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-5211
  • Fax: 989-729-4971
Mailing address:
  • Phone: 810-635-7453
  • Fax: 810-630-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KENDRA M HULL
Title or Position: BILLER
Credential:
Phone: 810-635-7453