Provider Demographics
NPI:1083079750
Name:COMMUNITY ANESTHESIA PROFESSIONALS PLLC
Entity Type:Organization
Organization Name:COMMUNITY ANESTHESIA PROFESSIONALS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KETOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-871-1145
Mailing Address - Street 1:PO BOX 14909
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0909
Mailing Address - Country:US
Mailing Address - Phone:612-871-1145
Mailing Address - Fax:612-870-5491
Practice Address - Street 1:2550 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 423 SOUTH
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1904
Practice Address - Country:US
Practice Address - Phone:612-871-1145
Practice Address - Fax:612-870-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty