Provider Demographics
NPI:1962823294
Name:CONTRI, CHAD RICHARD (CRNA MSN)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:RICHARD
Last Name:CONTRI
Suffix:
Gender:M
Credentials:CRNA MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:642 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9672
Practice Address - Country:US
Practice Address - Phone:812-723-7453
Practice Address - Fax:812-723-7500
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154687A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201222460Medicaid
IN163460052OtherMEDICARE PTAN
IN940070007OtherMEDICARE PTAN