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General NPI Number Information
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NPI Number | 1669643847
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Entity Type | Organization
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Legal Business Name | ANESTHESIA CONSULTANTS INC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 7232 ENGLE RD
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City | FORT WAYNE
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State | IN
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Zip | 46804-2222
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Country | US
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Telephone | 260-736-7205
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 BELL BROOK BLVD
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City | DECATUR
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State | IN
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Zip | 46733-7457
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Country | US
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Telephone | 260-724-2417
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HAVEN L DOVE
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Credential | CRNA
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Telephone | 260-724-2417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 28143888A
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License Number State | IN
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