MEDICARE: PETERSON ANESTHESIA INC

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	:	1497725477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSON ANESTHESIA INC

Provider Business Mailing Address
First Line	:	PO BOX 388
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-0388
Country	:	US
Telephone Number	:	316-281-3700
Fax Number	:	316-282-4322

Provider Business Practice Location Address
First Line	:	302 NORTH HOSPITAL DRIVE
Second Line	:
City	:	GIRARD
State	:	KS
Zip	:	66743
Country	:	US
Telephone Number	:	620-724-8291
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	JEANNIE MARIE PETERSON
Credential	:	CRNA
Telephone Number	:	620-724-8921

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/18/2011

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Directions to “PETERSON ANESTHESIA INC ” Practice Location

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