Provider Demographics
NPI:1811945702
Name:RIVERCHASE ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:RIVERCHASE ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:239-514-1310
Mailing Address - Street 1:6860 HUNTINGTON LAKES CIR
Mailing Address - Street 2:APT 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8022
Mailing Address - Country:US
Mailing Address - Phone:239-514-1310
Mailing Address - Fax:
Practice Address - Street 1:1005 CROSS POINT DR #2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-566-5748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty