Basic Information
| Provider Information | |||||||||
| NPI: | 1467513176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY ANESTHESIA ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 25TH ST S | ||||||||
| Address2: | SUITE K | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012341728 | ||||||||
| FaxNumber: | 7012341681 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 25TH ST S | ||||||||
| Address2: | SUITE K | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012341728 | ||||||||
| FaxNumber: | 7012341681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | CHALASANI | ||||||||
| AuthorizedOfficialFirstName: | NAGESWARARAO | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7012341728 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 732218600 | 01 | MN | MN MEDICAID | OTHER | 10220 | 05 | ND | MEDICAID | 00757001 | 01 | ND | NORTH DAKOTA BLUE SHIELD | OTHER | 53A49VA | 01 | MN | MN BLUE SHIELD | OTHER | CN8139 | 01 | ND | RR MEDICARE | OTHER |