Provider Demographics
NPI:1710092358
Name:IU ANESTHESIOLOGY ASSOCIATES-ICU, LLC
Entity Type:Organization
Organization Name:IU ANESTHESIOLOGY ASSOCIATES-ICU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRESSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:317-274-0269
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT 106
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:317-567-2191
Practice Address - Street 1:1120 SOUTH DR
Practice Address - Street 2:FESLER HALL, ROOM 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5135
Practice Address - Country:US
Practice Address - Phone:317-274-0269
Practice Address - Fax:317-614-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200849550AMedicaid
IN248400Medicare PIN