Provider Demographics
NPI:1477507689
Name:PIONEER ANESTHESIA CONSULTANTS, LLC
Entity Type:Organization
Organization Name:PIONEER ANESTHESIA CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:IMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-831-1160
Mailing Address - Street 1:2001 N GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-2110
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-213-3240
Practice Address - Street 1:1201 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1737
Practice Address - Country:US
Practice Address - Phone:317-831-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200096880Medicaid
IN200080640Medicaid
IN200006610AMedicaid
IN200080640Medicaid
IN200006610AMedicaid
G26290Medicare UPIN
137130DMedicare ID - Type UnspecifiedDR. MURRELL
F85996Medicare UPIN
137130GMedicare ID - Type UnspecifiedDR. KERR
137130EMedicare ID - Type UnspecifiedDR. FALK
H89512Medicare UPIN
G44668Medicare UPIN
IN200096880Medicaid