Basic Information
| Provider Information | |||||||||
| NPI: | 1437111879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST ANESTHESIA PARTNERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 WASHINGTON AVE | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | NEWPORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410711986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592914800 | ||||||||
| FaxNumber: | 8596558588 | ||||||||
| Practice Location | |||||||||
| Address1: | 11518 TILLBURY CV | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468452138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603381660 | ||||||||
| FaxNumber: | 2603381659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | BATILLER | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2603381660 | ||||||||
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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 | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200810870A | 05 | IN | MEDICAID |