Provider Demographics
NPI:1770727893
Name:EVANSVILLE ANESTHESIA ASSOCIATES LLC
Entity type:Organization
Organization Name:EVANSVILLE ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-691-9080
Mailing Address - Street 1:520 MARY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1677
Mailing Address - Country:US
Mailing Address - Phone:812-340-4517
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:520 MARY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1677
Practice Address - Country:US
Practice Address - Phone:812-473-0181
Practice Address - Fax:812-473-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200957370Medicaid
IN000000627158OtherANTHEM
IN262420Medicare PIN