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General NPI Number Information
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NPI Number | 1356370241
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Entity Type | Organization
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Legal Business Name | EDEN ANESTHESIA SERVICES INC.
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 31 N SAINT JOSEPH AVE
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City | NILES
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State | MI
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Zip | 49120-2207
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Country | US
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Telephone | 269-687-1424
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Fax | 269-687-1472
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Provider Business Mailing Address
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Address Line | 31 N SAINT JOSEPH AVE
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City | NILES
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State | MI
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Zip | 49120-2207
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Country | US
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Telephone | 269-687-1424
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Fax | 269-687-1472
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY LOU STROCK
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Credential |
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Telephone | 269-983-8195
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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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