Provider Demographics
NPI:1740456581
Name:ANESTHESIA PAIN SPECIALIST, LLC
Entity type:Organization
Organization Name:ANESTHESIA PAIN SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-887-7420
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3046
Mailing Address - Country:US
Mailing Address - Phone:317-614-9641
Mailing Address - Fax:317-614-9655
Practice Address - Street 1:6325 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7110
Practice Address - Country:US
Practice Address - Phone:317-781-0067
Practice Address - Fax:317-791-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200903580AMedicaid
INI35657Medicare UPIN
IN200903580AMedicaid