Provider Demographics
NPI:1700853421
Name:OTTUMWA ANESTHESIOLOGISTS PC
Entity Type:Organization
Organization Name:OTTUMWA ANESTHESIOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHASHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANGHNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-682-4115
Mailing Address - Street 1:312 E ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1413
Mailing Address - Country:US
Mailing Address - Phone:641-682-4115
Mailing Address - Fax:641-682-0005
Practice Address - Street 1:312 E ALTA VISTA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1413
Practice Address - Country:US
Practice Address - Phone:641-682-4115
Practice Address - Fax:641-682-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0072371Medicaid
IA03086Medicare ID - Type Unspecified