Provider Demographics
NPI:1114524147
Name:INDEPENDENCE ANESTHESIA LLC
Entity Type:Organization
Organization Name:INDEPENDENCE ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:870-613-8390
Mailing Address - Street 1:PO BOX 3283
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-3283
Mailing Address - Country:US
Mailing Address - Phone:870-613-8390
Mailing Address - Fax:
Practice Address - Street 1:1710 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4563
Practice Address - Country:US
Practice Address - Phone:870-613-8390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCO1386OtherSTATE LICENSE