Provider Demographics
NPI:1467530931
Name:SEFTON ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:SEFTON ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEFTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:812-738-7606
Mailing Address - Street 1:4680 OLD FOREST RD SW
Mailing Address - Street 2:PO BOX 952
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-6437
Mailing Address - Country:US
Mailing Address - Phone:812-738-7606
Mailing Address - Fax:812-634-7152
Practice Address - Street 1:2200 MARKET ST
Practice Address - Street 2:C/O ST CATHERINE'S REGIONAL HOSPITAL
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9553
Practice Address - Country:US
Practice Address - Phone:812-256-7676
Practice Address - Fax:812-256-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28104181A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000286565OtherANTHEM BCBS
IN200103090BMedicaid
IN1477647527OtherDYAN SEFTON PERSONAL PROVIDER NPI#
INR93375Medicare UPIN
IN000000286565OtherANTHEM BCBS