Healthcare Provider Details

I. General information

NPI: 1699931949
Provider Name (Legal Business Name): CMT ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 10TH ST
WACONIA MN
55387-4552
US

IV. Provider business mailing address

1400 EASTSIDE RD
PLATTEVILLE WI
53818-9800
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-9770
  • Fax: 952-442-3620
Mailing address:
  • Phone: 608-348-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRUCE BARTELS
Title or Position: PRESIDENT
Credential: CRNA
Phone: 608-342-4727