Provider Demographics
NPI:1639240682
Name:NEWBURGH ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NEWBURGH ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:812-490-3420
Mailing Address - Street 1:6055 LAUREL RIDGE DR
Mailing Address - Street 2:PO BOX 1225
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8066
Mailing Address - Country:US
Mailing Address - Phone:812-490-3420
Mailing Address - Fax:812-634-7152
Practice Address - Street 1:1900 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9521
Practice Address - Country:US
Practice Address - Phone:812-683-2121
Practice Address - Fax:812-683-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28151018A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210750Medicare PIN
INR79048Medicare UPIN