Provider Demographics
NPI:1790123263
Name:C HAMMERLY ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:C HAMMERLY ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMERLY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:317-873-9594
Mailing Address - Street 1:4300 TALLY HO CIR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8271
Mailing Address - Country:US
Mailing Address - Phone:574-268-9640
Mailing Address - Fax:
Practice Address - Street 1:1601 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3275
Practice Address - Country:US
Practice Address - Phone:765-453-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28143711A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty