MEDICARE: SPECTRUM ANESTHESIA & PAIN MANAGEMENT SERVICES, S.C.

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	20840	WY
2	367500000X	Certified Registered Nurse Anesthetist	40364	MT

General Provider Information

NPI Number	:	1205103306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM ANESTHESIA & PAIN MANAGEMENT SERVICES, S.C.

Provider Business Mailing Address
First Line	:	225 S EXECUTIVE DR
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4257
Country	:	US
Telephone Number	:	262-787-4026
Fax Number	:	262-782-6040

Provider Business Practice Location Address
First Line	:	1739 SPRING CREEK LANE SUITE 100
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102
Country	:	US
Telephone Number	:	615-301-8143
Fax Number	:	615-301-8152

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW B BAKER
Credential	:	CRNA
Telephone Number	:	262-787-4026

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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