Provider Demographics
NPI:1881689974
Name:CENTRAL MINNESOTA ANESTHESIA PROVIDERS, PA
Entity type:Organization
Organization Name:CENTRAL MINNESOTA ANESTHESIA PROVIDERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:763-218-4125
Mailing Address - Street 1:911 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-2172
Mailing Address - Country:US
Mailing Address - Phone:763-389-6384
Mailing Address - Fax:763-389-6389
Practice Address - Street 1:14054 BANK ST
Practice Address - Street 2:BOX 100
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-0100
Practice Address - Country:US
Practice Address - Phone:763-260-8808
Practice Address - Fax:763-645-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2015-11-02
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
MN003496700Medicaid
MN003496700Medicaid