Basic Information
| Provider Information | |||||||||
| NPI: | 1588715106 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKWAY ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 W STATE LINE ST | ||||||||
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| City: | FULTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420411263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 HOLIDAY LN | ||||||||
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| City: | FULTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420418468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOHLBEIN | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5736865550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 430029060 | 01 | KY | RR MEDICARE | OTHER | 74903915 | 05 | KY | MEDICAID | 4600035 | 05 | TN | MEDICAID | 000000053397 | 01 | KY | KY BCBS | OTHER |