Healthcare Provider Details

I. General information

NPI: 1174596373
Provider Name (Legal Business Name): R.K. ANESTHESIA SERVICES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 HART BLVD
MONTICELLO MN
55362-8575
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-2945
  • Fax:
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RALPH KIFFMEYER
Title or Position: OWNER
Credential: CRNA
Phone: 763-295-2945