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General NPI Number Information
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NPI Number | 1194761262
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Entity Type | Organization
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Legal Business Name | ANESTHESIOLOGY GROUP ASSOCIATES PC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 3700 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-0541
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Country | US
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Telephone | 812-491-1307
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Fax | 812-492-6307
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-491-1307
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Fax | 812-492-6307
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY L FUNKE
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Credential | MD
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Telephone | 812-491-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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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 | 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 #3
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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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