Healthcare Provider Details

I. General information

NPI: 1295842623
Provider Name (Legal Business Name): RED RIVER ANESTHESIA P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ST FRANCIS DR
BRECKENRIDGE MN
56520-1025
US

IV. Provider business mailing address

PO BOX 1296
WARSAW IN
46581-1296
US

V. Phone/Fax

Practice location:
  • Phone: 218-643-3000
  • Fax:
Mailing address:
  • Phone: 574-268-9640
  • Fax: 574-268-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT SPLICHAL
Title or Position: MANAGER
Credential: C.R.N.A.
Phone: 574-268-9640