MEDICARE: JPCANESTHESIA, 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
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1669767034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPCANESTHESIA, LLC

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

Provider Business Practice Location Address
First Line	:	1602 W 15TH AVE
Second Line	:	SUITE A
City	:	EMPORIA
State	:	KS
Zip	:	66801-5672
Country	:	US
Telephone Number	:	620-343-7200
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	JOSEPH CONROY
Credential	:
Telephone Number	:	316-281-3700

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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