Basic Information
| Provider Information | |||||||||
| NPI: | 1073059176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLETE ANESTHESIA & PAIN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 SAINT MARYS DR | ||||||||
| Address2: | STE 205W | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776103 | ||||||||
| FaxNumber: | 8124774897 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 SAINT MARYS DR | ||||||||
| Address2: | STE 205W | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776103 | ||||||||
| FaxNumber: | 8124774897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2017 | ||||||||
| LastUpdateDate: | 01/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | MOORS | ||||||||
| AuthorizedOfficialFirstName: | HUGH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8124776103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.