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General NPI Number Information
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NPI Number | 1336751023
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Entity Type | Organization
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Legal Business Name | CHIPPEWA VALLEY ANESTHESIA ASSOCIATES, S.C.
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 1000 OAKLEAF WAY
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City | ALTOONA
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State | WI
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Zip | 54720-2246
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Country | US
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Telephone | 800-635-6197
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 W CLAIREMONT AVE STE 2C
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6161
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Country | US
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Telephone | 715-834-8721
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Fax | 715-834-3087
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DEAN KELLNER
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Credential | MBA, FACMPE. CPA
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Telephone | 715-834-8721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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