Healthcare Provider Details

I. General information

NPI: 1225587504
Provider Name (Legal Business Name): NORTHSTAR ANESTHESIA OF KENTUCKY II, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

IV. Provider business mailing address

6225 N STATE HIGHWAY 161 SUITE 200
IRVING TX
75038-2223
US

V. Phone/Fax

Practice location:
  • Phone: 214-687-0001
  • Fax: 972-518-2100
Mailing address:
  • Phone: 214-687-0001
  • Fax: 972-518-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PHILIP EICHENHOLZ
Title or Position: PRESIDENT
Credential: MD
Phone: 214-687-0008