MEDICARE: DURGA ANESTHESIA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1043892102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURGA ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1889
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47308-1889
Country	:	US
Telephone Number	:	765-284-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 REGENCY PKWY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7823
Country	:	US
Telephone Number	:	765-284-0493
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DONNA BUCK
Credential	:
Telephone Number	:	765-284-0493

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	04/29/2021

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