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General NPI Number Information
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NPI Number | 1083639660
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Entity Type | Organization
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Legal Business Name | NORTHERN INDIANA ANESTHESIA SERVICES, P.C.
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 600 EAST BLVD
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City | ELKHART
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State | IN
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Zip | 46514
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Country | US
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Telephone | 574-523-3193
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Fax | 574-523-3464
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Provider Business Mailing Address
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Address Line | 7 PARKWAY CTR STE 375
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City | PITTSBURGH
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State | PA
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Zip | 15220
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Country | US
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Telephone | 412-937-5700
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Fax | 412-937-5947
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN S CHUNG
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Credential | MD
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Telephone | 574-523-3193
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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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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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