Healthcare Provider Details

I. General information

NPI: 1013960798
Provider Name (Legal Business Name): ANESTHESIOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

14700 28TH AVE N SUITE 20
PLYMOUTH MN
55447-4876
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-5370
  • Fax:
Mailing address:
  • Phone: 763-559-3779
  • Fax: 763-450-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOHN Y HENDRICKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 763-520-5370