Basic Information
| Provider Information | |||||||||
| NPI: | 1548433485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PKANESTHESIA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29504 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891269504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028780070 | ||||||||
| FaxNumber: | 7028181930 | ||||||||
| Practice Location | |||||||||
| Address1: | RT 1 BOX 53 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6604658511 | ||||||||
| FaxNumber: | 6604652956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | KEMP | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CRNA | ||||||||
| AuthorizedOfficialTelephone: | 7028780070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 134066 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.