Provider Demographics
NPI:1679585624
Name:CEOLA ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:CEOLA ANESTHESIA, PLLC
Other - Org Name:RCAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:479-531-7711
Mailing Address - Street 1:PO. BOX 172
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718
Mailing Address - Country:US
Mailing Address - Phone:479-531-7711
Mailing Address - Fax:479-631-2702
Practice Address - Street 1:8300 W BROWN RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-531-9083
Practice Address - Fax:479-631-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01036367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO917897811Medicaid
AR135884701Medicaid
MO917897811Medicaid
430045896Medicare ID - Type UnspecifiedRAILROAD MEDICARE