Provider Demographics
NPI:1114237500
Name:SHENANGO VALLEY ANESTHESIA INC
Entity Type:Organization
Organization Name:SHENANGO VALLEY ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:G
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-660-8505
Mailing Address - Street 1:310 LIGO RD
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-4936
Mailing Address - Country:US
Mailing Address - Phone:724-962-2272
Mailing Address - Fax:
Practice Address - Street 1:239 EDGEWOOD DRIVE EXT
Practice Address - Street 2:
Practice Address - City:TRANSFER
Practice Address - State:PA
Practice Address - Zip Code:16154-1817
Practice Address - Country:US
Practice Address - Phone:724-962-2272
Practice Address - Fax:706-660-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA367500000X, 367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty