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General NPI Number Information
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NPI Number | 1659749257
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Entity Type | Organization
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Legal Business Name | LOETSCHER ANESTHESIA, INC
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 09/13/2015
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Provider Practice Location Address
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Address Line | 4800 S HAZEL ST STE B
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City | PINE BLUFF
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State | AR
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Zip | 71603-6860
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Country | US
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Telephone | 870-718-0471
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1775
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City | PINE BLUFF
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State | AR
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Zip | 71613-1775
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Country | US
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Telephone | 870-718-0471
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN MATTHEW LOETSCHER
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Credential | CRNA
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Telephone | 870-718-0471
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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 | C002665
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License Number State | AR
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