Healthcare Provider Details

I. General information

NPI: 1538330204
Provider Name (Legal Business Name): INDEPENDENT ANESTHESIOLOGISTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 STATE RD
CINCINNATI OH
45255-2439
US

IV. Provider business mailing address

PO BOX 12749
COVINGTON KY
41012-0749
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD PARK
Title or Position: PRESIDENT
Credential:
Phone: 859-341-7246