Provider Demographics
NPI:1457339780
Name:NORTH METRO ANESTHESIA SERVICES P.A.
Entity Type:Organization
Organization Name:NORTH METRO ANESTHESIA SERVICES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELTY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:651-464-4611
Mailing Address - Street 1:5200 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8013
Mailing Address - Country:US
Mailing Address - Phone:651-464-4611
Mailing Address - Fax:651-464-7627
Practice Address - Street 1:5200 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8013
Practice Address - Country:US
Practice Address - Phone:651-464-4611
Practice Address - Fax:651-464-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2009-11-10
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
MN26532NOOtherBLUE CROSS
WI43790200Medicaid
MN2000495OtherMEDICA
MN116302OtherUCARE
MN184OtherHEALTHPARTNERS
MN405342700Medicaid
MN116302OtherUCARE