Provider Demographics
NPI:1124032537
Name:SURGERY CENTER ANESTHSIA
Entity Type:Organization
Organization Name:SURGERY CENTER ANESTHSIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRZELECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-233-3123
Mailing Address - Street 1:PO BOX 1742
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46634-1742
Mailing Address - Country:US
Mailing Address - Phone:574-233-3123
Mailing Address - Fax:574-233-3125
Practice Address - Street 1:53990 CARMICHAEL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1582
Practice Address - Country:US
Practice Address - Phone:574-233-3123
Practice Address - Fax:574-233-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX ID #