Organization
INDEPENDENT ANESTHESIOLOGISTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD ELDON PARK MD (PRESIDENT)
(859) 341-7246
Entity
Organization
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
PO BOX 12749, COVINGTON, KY 41012-0749
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000032124
ANTHEM BLUE SHIELD GROUP
—
05
—
0951653
—
OH
05
—
65911448
—
KY
05
—
74905910
—
KY
01
—
CD0121
RAILROAD MEDICARE GROUP
—
Enumeration date
11/10/2005
Last updated
04/20/2008
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