Basic Information
Provider Information
NPI: 1265615587
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTHWIND ANESTHESIA SERVICES, P.A.
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Mailing Information
Address1: 10310 STATE LINE RD
Address2: SUITE A
City: LEAWOOD
State: KS
PostalCode: 662062658
CountryCode: US
TelephoneNumber: 9136474100
FaxNumber: 9136474120
Practice Location
Address1: 10787 NALL AVE
Address2: SUITE 100
City: OVERLAND PARK
State: KS
PostalCode: 662111231
CountryCode: US
TelephoneNumber: 9133123710
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/10/2007
LastUpdateDate: 12/10/2007
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AuthorizedOfficialLastName: HULL
AuthorizedOfficialFirstName: TIMOTH
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9133123710
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialNamePrefix: DR.
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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