Basic Information
| Provider Information | |||||||||
| NPI: | 1114237500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHENANGO VALLEY ANESTHESIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 LIGO RD | ||||||||
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| City: | MERCER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161374936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249622272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 239 EDGEWOOD DRIVE EXT | ||||||||
| Address2: | |||||||||
| City: | TRANSFER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161541817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249622272 | ||||||||
| FaxNumber: | 7066601454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2010 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | JORDAN | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7066608505 | ||||||||
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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 | 367H00000X | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant | 367500000X | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.