Provider Demographics
NPI:1750500526
Name:METROPOLITAN ANESTHESIA ASSOCIATES, PC
Entity Type:Organization
Organization Name:METROPOLITAN ANESTHESIA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-808-3944
Mailing Address - Street 1:400 ANN ST NW
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2052
Mailing Address - Country:US
Mailing Address - Phone:616-808-3944
Mailing Address - Fax:
Practice Address - Street 1:1919 BOSTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4160
Practice Address - Country:US
Practice Address - Phone:616-252-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1912960675OtherDAVID KNIGHT CRNA
MI1679536718OtherTERESA KOELZER CRNA
MI4349131Medicaid
MI4718235Medicaid
MI1477522670OtherLAREE DEPIES CRNA
MI1598728636OtherSUSAN RUTHERFORD CRNA
MI4322138Medicaid
MI4537409Medicaid
MI4537409Medicaid
MI1679536718OtherTERESA KOELZER CRNA
MIP79508Medicare UPIN
MIM58670004Medicare ID - Type UnspecifiedTERESA KOELZER CRNA
MI4322138Medicaid
MIR40388Medicare UPIN
MIM58670007Medicare ID - Type UnspecifiedLAREE DEPIES CRNA
MI4718235Medicaid