Organization
ASSOCIATED ANESTHESIOLOGISTS OF FORT WAYNE PC
Active
Organization
ASSOCIATED ANESTHESIOLOGISTS OF FORT WAYNE PC
Active
Other names
Midwest Anesthesia Associates
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ANN JOLLEY (NATIONAL CREDENTIALING DIRECTOR)
(972) 715-5000
Entity
Organization
Contact information
Practice address
6435 W JEFFERSON BLVD # 434, FORT WAYNE, IN 46804-6203
(260) 436-7875
(260) 432-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-3603
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078204
—
OH
05
—
300017278
—
IN
05
—
300024710
—
IN
05
—
7100998850
—
KY
05
—
7100998980
—
KY
Enumeration date
10/25/2005
Last updated
10/21/2024
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