Provider Demographics
NPI:1356321434
Name:KLOEHN ANESTHESIS SERVICE, LLC
Entity Type:Organization
Organization Name:KLOEHN ANESTHESIS SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:608-661-0820
Mailing Address - Street 1:1200 JOHN Q HAMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1959
Mailing Address - Country:US
Mailing Address - Phone:608-661-9655
Mailing Address - Fax:608-826-2710
Practice Address - Street 1:1200 JOHN Q HAMMONS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1959
Practice Address - Country:US
Practice Address - Phone:608-661-9655
Practice Address - Fax:608-826-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43419400Medicaid
21405Medicare ID - Type Unspecified