Basic Information
| Provider Information | |||||||||
| NPI: | 1083612600 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND ANESTHESIA CONSULTANTS PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 639 N MULBERRY ST | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427011931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707374600 | ||||||||
| FaxNumber: | 2707371722 | ||||||||
| Practice Location | |||||||||
| Address1: | 639 N MULBERRY ST | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427011931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707374600 | ||||||||
| FaxNumber: | 2707371722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SPALDING | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2707374600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 65925968 | 05 | KY | MEDICAID |