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General NPI Number Information
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NPI Number | 1992212807
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ANESTHESIA SERVICES OF KENTUCKY PLLC
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 200 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1831
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Country | US
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Telephone | 214-687-0001
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Fax | 972-518-2100
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Provider Business Mailing Address
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Address Line | PO BOX 610691
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City | DALLAS
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State | TX
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Zip | 75261-0691
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Country | US
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Telephone | 239-610-0775
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP W EICHENHOLZ
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Credential | MD
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Telephone | 214-687-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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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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