Provider Demographics
NPI:1174509624
Name:KANE ANESTHESIA PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:KANE ANESTHESIA PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-837-8585
Mailing Address - Street 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:814-837-8585
Mailing Address - Fax:814-837-7992
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:814-837-8585
Practice Address - Fax:814-837-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1520056OtherBLUE SHIELD CRNA
PA1520061OtherBLUE SHIELD M.D.
PA1520056OtherBLUE SHIELD CRNA
PA=========OtherALL OTHER INSURANCES