Provider Demographics
NPI:1467513176
Name:VALLEY ANESTHESIA ASSOCIATES PC
Entity Type:Organization
Organization Name:VALLEY ANESTHESIA ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAGESWARARAO
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-234-1728
Mailing Address - Street 1:2301 25TH ST S
Mailing Address - Street 2:SUITE K
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6104
Mailing Address - Country:US
Mailing Address - Phone:701-234-1728
Mailing Address - Fax:701-234-1681
Practice Address - Street 1:2301 25TH ST S
Practice Address - Street 2:SUITE K
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6104
Practice Address - Country:US
Practice Address - Phone:701-234-1728
Practice Address - Fax:701-234-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN732218600OtherMN MEDICAID
ND10220Medicaid
ND00757001OtherNORTH DAKOTA BLUE SHIELD
MN53A49VAOtherMN BLUE SHIELD
NDCN8139OtherRR MEDICARE
NDN70815Medicare PIN