Basic Information
| Provider Information | |||||||||
| NPI: | 1285116293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN INDIANA SEDATION ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 BELLEVUE WAY NE STE 188 | ||||||||
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| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 SAINT MARYS DR STE 205W | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124776103 | ||||||||
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| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 09/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | BEAR | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8006602153 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.