Provider Demographics
NPI:1821654666
Name:PROVIDIAN ANESTHESIA LLC
Entity Type:Organization
Organization Name:PROVIDIAN ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEITER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:502-472-5020
Mailing Address - Street 1:12468 LA GRANGE RD STE 342
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-1901
Mailing Address - Country:US
Mailing Address - Phone:502-472-5020
Mailing Address - Fax:
Practice Address - Street 1:1169 EASTERN PKWY STE 400
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1412
Practice Address - Country:US
Practice Address - Phone:502-276-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty