Organization
EDEN ANESTHESIA SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LOU STROCK (DIRECTOR)
(269) 983-8195
Entity
Organization
Contact information
Practice address
31 N SAINT JOSEPH AVE, NILES, MI 49120-2207
(269) 687-1424
(269) 687-1472
Mailing address
31 N SAINT JOSEPH AVE, NILES, MI 49120-2207
(269) 687-1424
(269) 687-1472
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050A111210
BCBS-DR
MI
05
—
1356370241
—
MI
01
—
430A111200
BCBS-GROUP
MI
01
—
CB9923
MEDICARE RAILROAD GROUP
MI
Enumeration date
07/02/2006
Last updated
04/19/2018
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