Basic Information
| Provider Information | |||||||||
| NPI: | 1992988224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMSOL ANESTHETISTS OF INDIANA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2644 | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352022644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053221808 | ||||||||
| FaxNumber: | 2053221851 | ||||||||
| Practice Location | |||||||||
| Address1: | 4011 S TIWARI BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474038000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2007 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | HILLIARD | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3368841830 | ||||||||
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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.