# INDIANA REGIONAL MEDICAL CENTER - CRNA-IASA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INDIANA REGIONAL MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1891099636
- **Legal business name:** INDIANA REGIONAL MEDICAL CENTER
- **Authorized official:** MR. MICHAEL F ICKOWSKI CPA, MBA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (724) 357-7008

## Contact information

- **Practice address:** 841 HOSPITAL RD, INDIANA, PA 15701-3620
- **Practice address phone:** (724) 465-1922
- **Mailing address:** 1699 WASHINGTON RD, SUITE 307, PITTSBURGH, PA 15228-1629
- **Mailing address phone:** (412) 831-3744
- **Mailing address fax:** (412) 831-5663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/10/2011
- **Last updated:** 07/10/2024