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General NPI Number Information
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NPI Number | 1073781167
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Entity Type | Organization
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Legal Business Name | INDEPENDANT ANESTHESIOLOGISTS PSC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | ONE MEDICAL VILLAGE DRIVE
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City | EDGEWOOD
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State | KY
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Zip | 41017
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Country | US
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Telephone | 859-341-7246
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Fax | 859-341-7867
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Provider Business Mailing Address
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Address Line | 20 MEDICAL VILLAGE DRIVE 258
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City | EDGEWOOD
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State | KY
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Zip | 41017
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Country | US
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Telephone | 859-341-7246
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Fax | 859-341-7867
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD ELDON PARK
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Credential | MD
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Telephone | 859-341-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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