Basic Information
| Provider Information | |||||||||
| NPI: | 1689990871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY ANESTHESIA OF NORTHWEST INDIANA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 PARKWAY CTR | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152203704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129375947 | ||||||||
| FaxNumber: | 7702371492 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 GLENDALE BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463833767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194626144 | ||||||||
| FaxNumber: | 7702371492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4129375947 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.