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General NPI Number Information
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NPI Number | 1518359579
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Entity Type | Organization
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Legal Business Name | KP ANESTHESIA, PC
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Dates
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Enumeration Date | 02/28/2015
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 121 PROGRESS AVE STE 120S
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City | POTTSVILLE
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State | PA
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Zip | 17901-2968
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Country | US
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Telephone | 570-622-5622
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Fax | 570-622-5618
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Provider Business Mailing Address
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Address Line | 121 PROGRESS AVE STE 120
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City | POTTSVILLE
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State | PA
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Zip | 17901-2968
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Country | US
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Telephone | 570-622-5622
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Fax | 570-622-5618
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | INDU PAUL
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Credential |
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Telephone | 570-622-5616
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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 | MD418768
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License Number State | PA
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