Provider Demographics
NPI:1396834628
Name:NORTHERN ANESTHESIA PROVIDERS PC
Entity Type:Organization
Organization Name:NORTHERN ANESTHESIA PROVIDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUESING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-348-2795
Mailing Address - Street 1:602 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2220
Mailing Address - Country:US
Mailing Address - Phone:231-348-2795
Mailing Address - Fax:231-348-2031
Practice Address - Street 1:602 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2220
Practice Address - Country:US
Practice Address - Phone:231-348-2795
Practice Address - Fax:231-348-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0B46025OtherBLUE CROSS BLUE SHIELD