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NPI Code Detail

MEDICARE: NORTHSTAR ANESTHESIA OF INDIANA II, LLC

MEDICARE: NORTHSTAR ANESTHESIA OF INDIANA II, 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
1367500000XCertified Registered Nurse Anesthetist
2207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1629475421
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSTAR ANESTHESIA OF INDIANA II, LLC
Provider Business Mailing Address
First Line : PO BOX 610227
Second Line :
City : DALLAS
State : TX
Zip : 75261-0227
Country : US
Telephone Number : 239-610-0775
Fax Number :
Provider Business Practice Location Address
First Line : 6225 N STATE HIGHWAY 161
Second Line : SUITE 200
City : IRVING
State : TX
Zip : 75038-2241
Country : US
Telephone Number : 214-687-0675
Fax Number :
Authorized Official
Title or Position : REVENUE DIRECTOR
Name : MRS. REBECCA PETROSS
Credential :
Telephone Number : 214-687-0675
Provider Enumeration Date : 11/24/2014
Last Update Date : 05/25/2021

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