Provider Demographics
NPI:1558536623
Name:M. BEARDSLEE ANESTHESIA SVC. PSC
Entity Type:Organization
Organization Name:M. BEARDSLEE ANESTHESIA SVC. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BEARDSLEE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:574-267-6167
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-1296
Mailing Address - Country:US
Mailing Address - Phone:574-268-9640
Mailing Address - Fax:574-268-0684
Practice Address - Street 1:2101 DUBOIS DR
Practice Address - Street 2:MARILENE BEARDSLEE C/O KOSCIUSKO COMMUNITY HOSPITAL
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3210
Practice Address - Country:US
Practice Address - Phone:574-267-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28065229A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty