Basic Information
| Provider Information | |||||||||
| NPI: | 1336751023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHIPPEWA VALLEY ANESTHESIA ASSOCIATES, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W CLAIREMONT AVE STE 2C | ||||||||
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| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158348721 | ||||||||
| FaxNumber: | 7158343087 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 OAKLEAF WAY | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547202246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006356197 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | KELLNER | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7158348721 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA, FACMPE. CPA | ||||||||
| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.