Provider Demographics
NPI:1558673194
Name:DEMINT ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:DEMINT ANESTHESIA SERVICES, LLC
Other - Org Name:DEMINT ANESTHESIA SERVICES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:DEMINT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:913-515-9906
Mailing Address - Street 1:13900 WESTGATE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2896
Mailing Address - Country:US
Mailing Address - Phone:913-515-9906
Mailing Address - Fax:913-232-9247
Practice Address - Street 1:13900 WESTGATE ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-2896
Practice Address - Country:US
Practice Address - Phone:913-515-9906
Practice Address - Fax:913-232-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1356583072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437108750OtherNPI
1427002880OtherNPI
J229332OtherMEDICARE
MO918506502Medicaid
MO919002501Medicaid
KS203076071Medicaid
KS100458520Medicaid
J22C456Medicare PIN