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General NPI Number Information
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NPI Number | 1740456581
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Entity Type | Organization
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Legal Business Name | ANESTHESIA PAIN SPECIALIST, LLC
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 6325 S EAST ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-7110
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Country | US
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Telephone | 317-781-0067
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Fax | 317-791-1242
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Provider Business Mailing Address
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Address Line | PO BOX 3046
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3046
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Country | US
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Telephone | 317-614-9641
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Fax | 317-614-9655
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Authorized Official
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Title or Position | OWNER
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Name | LYDIA H FERRELL
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Credential | MD
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Telephone | 317-887-7420
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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 | IN
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | IN
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