Basic Information
| Provider Information | |||||||||
| NPI: | 1104089275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOXVILLE AREA ANESTHESIA SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 54 | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525370054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416643602 | ||||||||
| FaxNumber: | 6146643765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 S LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501383121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418422151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | ECK | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 6416643602 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | D065366 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.