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NPI Code Detail

MEDICARE: NORTHERN ANESTHESIA PROVIDERS, LLC

MEDICARE: NORTHERN ANESTHESIA PROVIDERS, LLC
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
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1356389704
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN ANESTHESIA PROVIDERS, LLC
Provider Business Mailing Address
First Line : 11518 TILLBURY CV
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-2138
Country : US
Telephone Number : 260-338-1660
Fax Number :
Provider Business Practice Location Address
First Line : 1316 E 7TH ST
Second Line :
City : AUBURN
State : IN
Zip : 46706-2523
Country : US
Telephone Number : 260-338-1660
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : GIL F MENDOZA
Credential : MD
Telephone Number : 260-338-1660
Provider Enumeration Date : 06/04/2006
Last Update Date : 08/22/2020

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Directions to “NORTHERN ANESTHESIA PROVIDERS, LLC ” Practice Location

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