Provider Demographics
NPI:1457538647
Name:SOUTHWEST ANESTHESIA INC
Entity type:Organization
Organization Name:SOUTHWEST ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTISS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:317-509-9896
Mailing Address - Street 1:12831 N MCCRACKEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-7020
Mailing Address - Country:US
Mailing Address - Phone:317-509-9896
Mailing Address - Fax:
Practice Address - Street 1:227 EAST MCCALLISTER DRIVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:765-832-7372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28114266A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty