Provider Demographics
NPI:1982653044
Name:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Entity Type:Organization
Organization Name:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Other - Org Name:COMMUNITY ANESTHESIOLOGISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL DIRECTOR PATIENT FINANCIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KULLERSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-8999
Mailing Address - Street 1:901 MACARTHUR BLVD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-7040
Practice Address - Fax:219-513-1127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200261490BOtherMDWISE
IN90000960OtherBCBS OF ILLINOIS
IN000000100902OtherANTHEM BCBS
IN200261490BMedicaid
INCE8881OtherMEDICARE RAILROAD
INCE8881OtherMEDICARE RAILROAD
INCA9120Medicare PIN