Provider Demographics
NPI:1629211057
Name:MIDWEST ANESTHESIA CORPORATION
Entity Type:Organization
Organization Name:MIDWEST ANESTHESIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRESS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:812-482-9617
Mailing Address - Street 1:602 3RD AVE
Mailing Address - Street 2:PO BOX 0488
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3601
Mailing Address - Country:US
Mailing Address - Phone:812-482-9617
Mailing Address - Fax:812-634-7152
Practice Address - Street 1:602 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3601
Practice Address - Country:US
Practice Address - Phone:812-482-9617
Practice Address - Fax:812-634-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28080901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1629211057OtherMIDWEST ANESTHESIA CORPORATION GROUP NPI #
IN261140OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
IN28080901OtherCRNA MEDICAL LICENSE #
IN1982636536OtherPERSONAL NPI
INR20636Medicare UPIN