Provider Demographics
NPI:1225575624
Name:ICD8U ANESTHESIA, LLC
Entity Type:Organization
Organization Name:ICD8U ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:785-840-5855
Mailing Address - Street 1:3701 SW KINGS FOREST RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-1556
Mailing Address - Country:US
Mailing Address - Phone:785-840-5855
Mailing Address - Fax:
Practice Address - Street 1:3630 SW FAIRLAWN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-3966
Practice Address - Country:US
Practice Address - Phone:785-273-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43-55189-092367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000145012OtherBCBS
KSP00109578OtherRAILROAD
KSP00109578OtherRAILROAD