Provider Demographics
NPI:1669643847
Name:ANESTHESIA CONSULTANTS INC
Entity Type:Organization
Organization Name:ANESTHESIA CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:260-724-2417
Mailing Address - Street 1:1409 BELL BROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-7457
Mailing Address - Country:US
Mailing Address - Phone:260-724-2417
Mailing Address - Fax:
Practice Address - Street 1:7232 ENGLE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2222
Practice Address - Country:US
Practice Address - Phone:260-736-7205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28143888A261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery