Provider Demographics
NPI:1295842623
Name:RED RIVER ANESTHESIA P C
Entity Type:Organization
Organization Name:RED RIVER ANESTHESIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPLICHAL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:574-268-9640
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-1296
Mailing Address - Country:US
Mailing Address - Phone:574-268-9640
Mailing Address - Fax:574-268-0684
Practice Address - Street 1:2400 ST FRANCIS DR
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1025
Practice Address - Country:US
Practice Address - Phone:218-643-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCG1606OtherPALMETTO GPA - MEDICARE RAIL ROAD
MN22L73REOtherBLUE CROSS BLUE SHIELD BLUE PLUS OF MINNESOTA
NDCG1606OtherPALMETTO GPA - MEDICARE RAIL ROAD
MN053783700Medicaid
ND11090Medicaid
ND70921Medicare PIN
NDCG1606OtherPALMETTO GPA - MEDICARE RAIL ROAD