Provider Demographics
NPI:1528014362
Name:GOSHEN ANESTHESIOLOGY LLC
Entity Type:Organization
Organization Name:GOSHEN ANESTHESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POOPALASINGHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POOVENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-273-6546
Mailing Address - Street 1:P O BOX 661172
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0001
Mailing Address - Country:US
Mailing Address - Phone:574-273-6546
Mailing Address - Fax:574-273-5295
Practice Address - Street 1:200 HIGH PARK AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4810
Practice Address - Country:US
Practice Address - Phone:574-273-6546
Practice Address - Fax:574-273-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN185840Medicare ID - Type Unspecified